Healthcare Provider Details

I. General information

NPI: 1023526365
Provider Name (Legal Business Name): J&L DENTAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HERITAGE TRACE PARKWAY SUITE 121
FORT WORTH TX
76177
US

IV. Provider business mailing address

8925 HAAS DR
FORT WORTH TX
76244-9126
US

V. Phone/Fax

Practice location:
  • Phone: 817-210-6062
  • Fax: 817-768-2277
Mailing address:
  • Phone: 801-673-1100
  • Fax: 817-768-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA LLOYD MCPHEE
Title or Position: OWNER
Credential: DDS
Phone: 801-673-1100