MEDICARE: 3515 SYCAMORE SCHOOL RD PLLC

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

General Provider Information

NPI Number	:	1942927843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3515 SYCAMORE SCHOOL RD PLLC

Provider Business Mailing Address
First Line	:	2401 E RANDOL MILL RD STE 520
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-6380
Country	:	US
Telephone Number	:	817-809-4860
Fax Number	:	682-626-1824

Provider Business Practice Location Address
First Line	:	3515 SYCAMORE SCHOOL RD STE 170
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7823
Country	:	US
Telephone Number	:	817-809-4860
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GUNJAN DHIR
Credential	:	DDS
Telephone Number	:	817-809-4860

Provider Enumeration Date	:	10/21/2022
Last Update Date	:	10/21/2022

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