MEDICARE: HALLMARK FAMILY DENTAL PA

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	20467	TX

General Provider Information

NPI Number	:	1801261003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLMARK FAMILY DENTAL PA

Provider Business Mailing Address
First Line	:	1801 PRECINCT LINE RD STE A
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-3171
Country	:	US
Telephone Number	:	817-577-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 BELLVUE DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76134-5416
Country	:	US
Telephone Number	:	817-293-2088
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAIVAN KEVIN AFKAMI
Credential	:
Telephone Number	:	817-577-9200

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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Directions to “HALLMARK FAMILY DENTAL PA ” Practice Location

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