MEDICARE: HARRY M. STIMMEL LLC

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	1223P0221X	Pediatric Dentistry	14439	TX

General Provider Information

NPI Number	:	1710342977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRY M. STIMMEL LLC

Provider Business Mailing Address
First Line	:	3050 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7771
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7771
Country	:	US
Telephone Number	:	817-370-0021
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	HARRY STIMMEL
Credential	:	DMD
Telephone Number	:	817-370-0021

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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