MEDICARE: PIONEER DENTAL, P.A.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649368473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER DENTAL, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 7325
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-0325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E PIONEER PKWY
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	TX
Zip	:	76010-6422
Country	:	US
Telephone Number	:	817-265-6500
Fax Number	:	817-265-6508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT E. TAFEL
Credential	:	D.D.S.
Telephone Number	:	214-420-7000

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/18/2016

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