MEDICARE: DENTAL REPUBLIC- SEMINARY

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1578144036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL REPUBLIC- SEMINARY

Provider Business Mailing Address
First Line	:	3211 W NORTHWEST HWY #100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-5944
Country	:	US
Telephone Number	:	972-204-5231
Fax Number	:	214-242-4455

Provider Business Practice Location Address
First Line	:	1114 E SEMINARY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2830
Country	:	US
Telephone Number	:	972-747-9800
Fax Number	:	214-242-4455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SON TRAN
Credential	:	DDS
Telephone Number	:	972-204-5231

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	04/16/2021

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Directions to “DENTAL REPUBLIC- SEMINARY ” Practice Location

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