MEDICARE: SYCAMORE SCHOOL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1033686308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYCAMORE SCHOOL PLLC

Provider Business Mailing Address
First Line	:	3550 HULEN ST STE C
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6885
Country	:	US
Telephone Number	:	817-732-9341
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7771
Country	:	US
Telephone Number	:	817-732-9341
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN WARCUP
Credential	:	DDS
Telephone Number	:	817-732-9341

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	09/19/2023

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