Fort Worth Dental Valid NPI
Organization · Dentist · Fort Worth, TX
- NPI
- 1104939024
- Type
- Organization (Type 2)
- Primary specialty
- Dentist
- Specialty group
- Dental Providers
- Taxonomy code
- 122300000X
- License number
- 13209 (TX)
- Enumerated
- 2006-08-16
- Last updated
- 2012-10-11
Practice location
4620 Citylake Blvd W
Fort Worth, TX 76132-3695
(817) 263-0202