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General NPI Number Information
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NPI Number | 1386910065
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY OF TEXOMA
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 4506 KEMP BLVD.
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City | WICHITA FALLS
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State | TX
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Zip | 76308
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Country | US
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Telephone | 940-723-0435
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Fax | 940-766-4241
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Provider Business Mailing Address
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Address Line | PO BOX 9050
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City | WICHITA FALLS
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State | TX
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Zip | 76308-9050
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Country | US
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Telephone | 940-723-0435
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Fax | 940-766-4241
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. STACY FINLEY
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Credential |
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Telephone | 940-723-0435
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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 | 20198
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22228
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License Number State | TX
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