Healthcare Provider Details

I. General information

NPI: 1386862514
Provider Name (Legal Business Name): SHEILA T BIRTH D.D.S. M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 BASSWOOD BLVD STE 107
FORT WORTH TX
76137-4499
US

IV. Provider business mailing address

5407 BASSWOOD BLVD STE 107
FORT WORTH TX
76137-4499
US

V. Phone/Fax

Practice location:
  • Phone: 817-348-0910
  • Fax: 817-348-0422
Mailing address:
  • Phone: 817-348-0910
  • Fax: 817-348-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number07979621
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: