| Michael D Vaclav Dds & Ryan Street Dds | |
|
4525 Van Winkle Amarillo TX 79119 | |
| (806) 355-7463 | |
| (806) 355-6014 |
| Full Name | Michael D Vaclav Dds & Ryan Street Dds |
|---|---|
| Speciality | Dentist |
| Location | 4525 Van Winkle, Amarillo, Texas |
| Authorized Official Name and Position | Michael D Vaclav (PARTNER) |
| Authorized Official Contact | 8063557463 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael D Vaclav Dds & Ryan Street Dds 4525 Van Winkle Amarillo TX 79119 Ph: (806) 355-7463 | Michael D Vaclav Dds & Ryan Street Dds 4525 Van Winkle Amarillo TX 79119 Ph: (806) 355-7463 |
| NPI Number | 1356517650 |
|---|---|
| Provider Enumeration Date | 05/06/2008 |
| Last Update Date | 05/26/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356517650 | NPI | - | NPPES |
| 1578606901 | Other | TX | RYAN STREET DDS |
| 0095226-01 | Medicaid | TX | |
| 1710020177 | Other | TX | MICHAEL VACLAV DDS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 10364 (Texas) | Primary |
| 122300000X | Dentist | 21834 (Texas) | Secondary |
| 1223G0001X | Dentist - General Practice | 21834 (Texas) | Secondary |
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