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General NPI Number Information
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NPI Number | 1962544395
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Entity Type | Organization
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Legal Business Name | DR. SHEILA BIRTH-ORTHODONTICS-KELLER, LLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 4420 HERITAGE TRACE PKWY STE 300
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City | FORT WORTH
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State | TX
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Zip | 76244-8904
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Country | US
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Telephone | 817-348-0910
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 HERITAGE TRACE PKWY STE 300
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City | FORT WORTH
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State | TX
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Zip | 76244-8904
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Country | US
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Telephone | 817-348-0910
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | SHEILA BIRTH
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Credential | D. D.S., M.S.
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Telephone | 817-348-0910
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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 | 14150
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License Number State | TX
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