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General NPI Number Information
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NPI Number | 1124836986
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Entity Type | Organization
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Legal Business Name | COVENANT DENTAL CARE PLLC
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 512 W BONDS RANCH RD STE 100
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City | FORT WORTH
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State | TX
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Zip | 76131-3914
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Country | US
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Telephone | 817-204-6686
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 WINDSOR CT
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City | BEDFORD
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State | TX
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Zip | 76022-7858
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARK MEHANY
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Credential | DDS
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Telephone | 817-204-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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