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General NPI Number Information
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NPI Number | 1710289061
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Entity Type | Organization
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Legal Business Name | MANSFIELD FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 100 CARLIN RD
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City | MANSFIELD
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State | TX
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Zip | 76063-3454
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Country | US
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Telephone | 817-473-0291
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Fax | 682-518-1190
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Provider Business Mailing Address
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Address Line | 100 CARLIN RD
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City | MANSFIELD
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State | TX
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Zip | 76063-3454
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Country | US
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Telephone | 817-473-0291
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Fax | 682-518-1190
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Authorized Official
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Title or Position | RDH/OFFICE MANAGER
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Name | MRS. TERRI BRENTLINGER BAUER
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Credential | RDH
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Telephone | 817-473-0291
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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 | 24538
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12539
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License Number State | TX
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