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General NPI Number Information
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NPI Number | 1629873708
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Entity Type | Organization
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Legal Business Name | IG DENTAL
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2469 FOREST PARK BLVD
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City | FORT WORTH
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State | TX
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Zip | 76110-1731
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Country | US
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Telephone | 817-924-6211
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Fax | 817-924-6212
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Provider Business Mailing Address
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Address Line | 2469 FOREST PARK BLVD
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City | FORT WORTH
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State | TX
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Zip | 76110-1731
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Country | US
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Telephone | 817-924-6211
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Fax | 817-924-6212
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | FAREED IGHANI
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Credential | D.D.S.
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Telephone | 469-766-0906
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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 |
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License Number State |
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