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General NPI Number Information
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NPI Number | 1437467768
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Entity Type | Organization
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Legal Business Name | WEST KELLER DENTAL
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 4532 GOLDEN TRIANGLE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76244-6316
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Country | US
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Telephone | 817-431-5953
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Fax | 817-431-5913
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Provider Business Mailing Address
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Address Line | 4532 GOLDEN TRIANGLE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76244-6316
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Country | US
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Telephone | 817-431-5953
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Fax | 817-431-5913
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHIRAG S PATEL
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Credential | DDS
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Telephone | 817-431-5953
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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 | 24211
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License Number State | TX
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