MEDICARE: DR. CHRISTOPHER SHAWN PACK D.D.S.

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	21410	TX

General Provider Information

NPI Number	:	1689724361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER SHAWN PACK D.D.S.

Provider Business Mailing Address
First Line	:	7430 N BEACH ST
Second Line	:	SUITE 312
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1541
Country	:	US
Telephone Number	:	817-656-7373
Fax Number	:	817-656-7878

Provider Business Practice Location Address
First Line	:	7430 N BEACH ST
Second Line	:	SUITE 312
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1541
Country	:	US
Telephone Number	:	817-656-7373
Fax Number	:	817-656-7878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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