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General NPI Number Information
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NPI Number | 1023367257
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Entity Type | Organization
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Legal Business Name | ALSBURY DENTAL
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 699 NE ALSBURY BLVD
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City | BURLESON
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State | TX
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Zip | 76028-2660
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Country | US
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Telephone | 817-295-3070
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Fax | 817-295-3250
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Provider Business Mailing Address
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Address Line | 699 NE ALSBURY BLVD
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City | BURLESON
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State | TX
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Zip | 76028-2660
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Country | US
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Telephone | 817-295-3070
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Fax | 817-295-3250
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE FOUST
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Credential | DDS
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Telephone | 817-295-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14855
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License Number State | TX
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