Fort Worth Dental is a Dentist in Fort Worth, Texas. Fort Worth Dental practices all healthcare services and medical treatments related to Dentist. The NPI Number for Fort Worth Dental is 1104939024. The last update date is 2012-10-11.
Fort Worth Dental's current location address is 4620 Citylake Blvd W, Fort Worth, Texas. You can contact this provider via phone number 8172630202 and fax number 8179277197. The mailing address for Fort Worth Dental is 4620 Citylake Blvd W, Fort Worth, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Fort Worth Dental |
|---|---|
| Address | 4620 Citylake Blvd W, Fort Worth, Texas |
| Phone Number | 8172630202 |
| Fax Number | 8179277197 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Mund Jackson Arthur |
| Credentials | D.D.S. |
| Telephone Number | 8172630202 |
NPI Number Detail
| NPI Number | 1104939024 |
|---|---|
| Provider Enumeration Date | 2006-08-16 |
| Last Updated Date | 2012-10-11 |
Provider Mailing Address Detail
| Address | 4620 Citylake Blvd W |
|---|---|
| City | Fort Worth |
| State | Texas (TX) |
| Post Code | 761323695 |
| Phone Number | 8172630202 |
| Fax Number | 8179277197 |
Provider's Primary Taxonomy Detail
| Speciality | Dentist |
|---|---|
| Taxonomy | 122300000X |
| Licence No | 13209 |
|
Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 809903 | TX | UNITED CONCORDIA # | |
| 25DG | TX | BCBS OF TX PROVIDER # | |
| 84D741 | TX | BCBS PROVIDER # |
Post Comment/ Review Below
What is the Fort Worth Dental's unique identification number?
The Fort Worth Dental has been assigned the NPI (National Provider Identifier) Number 1104939024 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you provide the complete address where Fort Worth Dental is physically located?
The Fort Worth Dental is situated at the following address: 4620 Citylake Blvd W, Fort Worth, TX 761323695.
What is the Fort Worth Dental's specialty and taxonomy code?
The Fort Worth Dental's specialty is Dentist, and the corresponding taxonomy code is 122300000X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1104939024 to Fort Worth Dental?
The Centers for Medicare & Medicaid Services originally issued the 1104939024 to Fort Worth Dental on 2006-08-16.
As of what date were the Fort Worth Dental's details last updated?
The information pertaining to the Fort Worth Dental, including its address, specialty, and other details, was most recently updated on 2012-10-11.
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