Healthcare Provider Details

I. General information

NPI: 1609332733
Provider Name (Legal Business Name): NORTH TEXAS BOULEVARD DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N TEXAS BLVD
WESLACO TX
78596-4808
US

IV. Provider business mailing address

3600 E MCKINNEY ST STE 100
DENTON TX
76209-7557
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-7833
  • Fax: 855-731-5147
Mailing address:
  • Phone:
  • Fax:

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: CRAIG COPELAND
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 940-220-7833