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General NPI Number Information
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NPI Number | 1124849336
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Entity Type | Organization
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Legal Business Name | NORTHWEST HIGHWAY FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 10675 E NORTHWEST HWY STE 16501655
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City | DALLAS
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State | TX
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Zip | 75238-4838
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Country | US
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Telephone | 940-220-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 N I 35 STE 205
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City | DENTON
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State | TX
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Zip | 76207-1438
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Country | US
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Telephone | 940-220-7833
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | TYLER CARLSON
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Credential | DMD
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Telephone | 480-313-7759
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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 |
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License Number State |
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