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General NPI Number Information
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NPI Number | 1851834006
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS HERITAGE DENTAL PLLC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 4041 W WHEATLAND RD #202
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City | DALLAS
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State | TX
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Zip | 75237-4063
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Country | US
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Telephone | 281-630-2193
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Fax |
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Provider Business Mailing Address
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Address Line | 902 W YEAGUA ST
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City | GROESBECK
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State | TX
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Zip | 76642-3526
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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 | PRESIDENT
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Name | DR. MICHAEL STEVENS
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Credential | D.D.S.
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Telephone | 281-630-2193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22841
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License Number State | TX
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