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General NPI Number Information
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NPI Number | 1083098453
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Entity Type | Organization
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Legal Business Name | TMAA, PLLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 4109 BROWN TRAIL SUITE 102
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City | FORT WORTH
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State | TX
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Zip | 76304-3940
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Country | US
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Telephone | 181-742-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 BROWN TRAIL SUITE 102
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City | FORT WORTH
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State | TX
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Zip | 76304-3940
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Country | US
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Telephone | 181-742-8770
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | TUONG TA
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Credential | DDS
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Telephone | 817-428-7704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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