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General NPI Number Information
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NPI Number | 1124332556
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Entity Type | Organization
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Legal Business Name | FAIRVIEW-ALLEN ORTHODONTICS, PA
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 431 STACY RD SUITE 109
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City | FAIRVIEW
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State | TX
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Zip | 75069-8741
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Country | US
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Telephone | 972-727-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 431 STACY RD SUITE 109
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City | FAIRVIEW
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State | TX
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Zip | 75069-8741
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Country | US
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Telephone | 972-727-3900
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ALLEN A GANDY
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Credential | DDS, MS
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Telephone | 972-727-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 20817
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License Number State | TX
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