Healthcare Provider Details

I. General information

NPI: 1942927843
Provider Name (Legal Business Name): 3515 SYCAMORE SCHOOL RD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SYCAMORE SCHOOL RD STE 170
FORT WORTH TX
76133-7823
US

IV. Provider business mailing address

2401 E RANDOL MILL RD STE 520
ARLINGTON TX
76011-6380
US

V. Phone/Fax

Practice location:
  • Phone: 817-809-4860
  • Fax:
Mailing address:
  • Phone: 817-809-4860
  • Fax: 682-626-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GUNJAN DHIR
Title or Position: OWNER
Credential: DDS
Phone: 817-809-4860