Healthcare Provider Details

I. General information

NPI: 1407256233
Provider Name (Legal Business Name): HURST CITY FAMILY AND COSMETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W HARWOOD RD STE A
HURST TX
76054-3048
US

IV. Provider business mailing address

2100 REEVES RD
DECATUR TX
76234-3855
US

V. Phone/Fax

Practice location:
  • Phone: 817-369-3290
  • Fax: 817-369-3292
Mailing address:
  • Phone: 940-627-8400
  • Fax: 940-627-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25799
License Number StateTX

VIII. Authorized Official

Name: DR. CHRISTIAN UMUNNA NWOKORIE
Title or Position: CEO
Credential: DMD
Phone: 347-439-8901