Healthcare Provider Details

I. General information

NPI: 1427222017
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 MERRIMAC CIR STE 209
FORT WORTH TX
76107-6526
US

IV. Provider business mailing address

1533 MERRIMAC CIR STE 209
FORT WORTH TX
76107-6526
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-0007
  • Fax: 817-332-0008
Mailing address:
  • Phone: 817-332-0007
  • Fax: 817-332-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number19221
License Number StateTX

VIII. Authorized Official

Name: DR. ISABEL DE ROSAS BRITAIN
Title or Position: DENTIST
Credential: D.D.S.
Phone: 817-332-0007