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General NPI Number Information
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NPI Number | 1942862503
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Entity Type | Individual
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Provider Name | MARC ADAM FRUITHANDLER DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 213 NORTH MURPHY ROAD SUITE 700
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City | MURPHY
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State | TX
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Zip | 75094
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Country | US
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Telephone | 972-363-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 150 WINDING HOLLOW LN
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City | COPPELL
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State | TX
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Zip | 75019-2249
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Country | US
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Telephone | 214-228-6725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 33840
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License Number State | TX
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