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General NPI Number Information
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NPI Number | 1932329562
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Entity Type | Organization
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Legal Business Name | DFW ENDODONTIC ASSOCIATES, P.A.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1750 CAVENDER DR
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City | HURST
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State | TX
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Zip | 76054-3546
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Country | US
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Telephone | 817-268-8340
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Fax | 817-268-3835
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Provider Business Mailing Address
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Address Line | 1750 CAVENDER DR
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City | HURST
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State | TX
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Zip | 76054-3546
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Country | US
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Telephone | 817-268-8340
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Fax | 817-268-3835
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. STEVEN DAZEY
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Credential | D.M.D.
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Telephone | 817-268-8340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17407
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License Number State | TX
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