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General NPI Number Information
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NPI Number | 1407195290
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Entity Type | Organization
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Legal Business Name | TEXAS DENTURE CLINIC, PC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 1414 TEXAS ST
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City | FORT WORTH
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State | TX
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Zip | 76102-3426
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Country | US
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Telephone | 817-336-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 TEXAS ST
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City | FORT WORTH
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State | TX
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Zip | 76102-3426
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Country | US
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Telephone | 817-336-2121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON CLARK DAMON JR.
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Credential | DDS
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Telephone | 806-584-7991
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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 | 27147
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License Number State | TX
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