Healthcare Provider Details

I. General information

NPI: 1649723826
Provider Name (Legal Business Name): LINCOLN HEPWORTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S CARRIER PKWY
GRAND PRAIRIE TX
75051-1511
US

IV. Provider business mailing address

15470 TEALWOOD LN
FRISCO TX
75035-3602
US

V. Phone/Fax

Practice location:
  • Phone: 214-235-0408
  • Fax:
Mailing address:
  • Phone: 208-390-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: