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General NPI Number Information
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NPI Number | 1174194732
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Entity Type | Organization
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Legal Business Name | OPEN MOUTH, PLLC.
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 310 NW JOHN JONES DR STE 100
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City | BURLESON
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State | TX
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Zip | 76028-5788
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Country | US
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Telephone | 817-900-0764
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Fax | 818-242-5283
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Provider Business Mailing Address
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Address Line | 310 NW JOHN JONES DR STE 100
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City | BURLESON
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State | TX
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Zip | 76028-5788
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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 | OFFICE MANAGER
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Name | NICOLE GREEN
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Credential |
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Telephone | 817-900-0764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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