MEDICARE: FLOSS FT WORTH PC

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	20239	TX
2	122300000X	Dentist	25784	TX
3	1223G0001X	General Practice Dentistry	20239	TX

General Provider Information

NPI Number	:	1760781595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOSS FT WORTH PC

Provider Business Mailing Address
First Line	:	2421 W 7TH ST STE 103
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-2325
Country	:	US
Telephone Number	:	817-529-1600
Fax Number	:	817-529-1601

Provider Business Practice Location Address
First Line	:	2421 W 7TH ST STE 103
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-2325
Country	:	US
Telephone Number	:	817-529-1600
Fax Number	:	817-529-1601

Authorized Official
Title or Position	:	CEO
Name	:	DR. CLINTON F HERZOG
Credential	:	DDS
Telephone Number	:	214-871-7100

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

Similar Medicare Providers

1790670479 — LAUREN RYAN LCSW
Practice Location Address:

2421 W 7TH ST STE 105
FORT WORTH, TX
76107-2325

Practice Phone: 817-482-5663
Practice Fax:

1730202466 — MR. JAMES EDWARD BALLENGER LCSW
Practice Location Address:

4200 SOUTH FWY STE 2325
FORT WORTH, TX
76115-1400

Practice Phone: 817-975-8015
Practice Fax: 817-361-9958

1740830645 — DIESERU HEALTHCARE SERVICES LLC.
Practice Location Address:

2325 WOODMONT TRAIL
FORTH WORTH, TX
76133

Practice Phone: 682-360-1115
Practice Fax:

1124014089 — SARA C MICHAEL ARNP
Practice Location Address:

6100 WESTERN PL STE 800
FT WORTH, TX
76107-4679

Practice Phone: 877-868-4827
Practice Fax:

1770569931 — PAULA KAY FONTENOTE ANP
Practice Location Address:

401 FOCH ST APT 1436
FT WORTH, TX
76107-2598

Practice Phone: 501-463-0876
Practice Fax:

1033160015 — MONTICELLO DIAGNOSTIC IMAGING LP
Practice Location Address:

3712 W 7TH ST
FT WORTH, TX
76107-2536

Practice Phone: 817-377-3800
Practice Fax:

Directions to “FLOSS FT WORTH PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.