MEDICARE: BASSWOOD FAMILY DENTAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19297	TX

General Provider Information

NPI Number	:	1346396371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASSWOOD FAMILY DENTAL PA

Provider Business Mailing Address
First Line	:	5428 BASSWOOD BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137
Country	:	US
Telephone Number	:	817-788-7700
Fax Number	:	817-281-0055

Provider Business Practice Location Address
First Line	:	5428 BASSWOOD BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137
Country	:	US
Telephone Number	:	817-788-7700
Fax Number	:	817-281-0055

Authorized Official
Title or Position	:	DENTIST
Name	:	HARVEEN DHILLON HANS
Credential	:	DDS
Telephone Number	:	817-788-7700

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	01/02/2014

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