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General NPI Number Information
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NPI Number | 1326971367
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Entity Type | Organization
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Legal Business Name | RED DIRT DENTAL PLLC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 104 WATER OAKS BLVD STE B
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City | LINDALE
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State | TX
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Zip | 75771-2661
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Country | US
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Telephone | 903-977-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WATER OAKS BLVD STE B
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City | LINDALE
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State | TX
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Zip | 75771-2661
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Country | US
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Telephone | 903-977-0290
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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 | DR. TREVOR JUSTIN WORTLEY
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Credential | D.M.D.
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Telephone | 801-889-8321
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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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