Healthcare Provider Details

I. General information

NPI: 1609561224
Provider Name (Legal Business Name): SNC DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 GOLDEN TRIANGLE BLVD STE 101
FORT WORTH TX
76177-7166
US

IV. Provider business mailing address

3401 GOLDEN TRIANGLE BLVD STE 101
FORT WORTH TX
76177-7166
US

V. Phone/Fax

Practice location:
  • Phone: 817-500-0377
  • Fax:
Mailing address:
  • Phone: 817-500-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SANG KWON SEO
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 412-999-0743