=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073673224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS. BIRTH & STEWART-ORTHODONTICS-FT WORTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 10/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3060 SYCAMORE SCHOOL RD
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-7771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-370-0268
-----------------------------------------------------
Fax | 817-263-9217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 330874
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76163-0874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-370-0268
-----------------------------------------------------
Fax | 817-263-9217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. SHEILA T. BIRTH
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 817-370-0268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 14150
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------