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General NPI Number Information
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NPI Number | 1356990519
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Entity Type | Organization
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Legal Business Name | 1221 DENTAL FAMILY BUSINESS, PLLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 6435 S FM 549 STE 200
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City | HEATH
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State | TX
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Zip | 75032-6224
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Country | US
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Telephone | 972-722-4376
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Fax | 469-264-7148
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Provider Business Mailing Address
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Address Line | 6435 S FM 549 STE 200
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City | HEATH
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State | TX
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Zip | 75032-6224
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Country | US
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Telephone | 972-722-4376
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Fax | 469-264-7148
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM DOUGLASS BEABER
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Credential | DMD
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Telephone | 972-722-4376
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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 |
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License Number State |
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