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General NPI Number Information
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NPI Number | 1669162574
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Entity Type | Organization
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Legal Business Name | NTDS GRAPEVINE
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 1600 W NORTHWEST HWY STE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-8135
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Country | US
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Telephone | 817-251-4888
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Fax | 817-251-9777
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Provider Business Mailing Address
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Address Line | 5980 CHARLESTOWN DR
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City | DALLAS
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State | TX
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Zip | 75230-1706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DANIEL CHOI
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Credential |
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Telephone | 817-251-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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