MEDICARE: TIMBER CREEK ORTHODONTICS, P.A.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	20625	TX

General Provider Information

NPI Number	:	1063798718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBER CREEK ORTHODONTICS, P.A.

Provider Business Mailing Address
First Line	:	12650 N BEACH ST
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4243
Country	:	US
Telephone Number	:	817-562-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	12650 N BEACH ST
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4243
Country	:	US
Telephone Number	:	817-562-3292
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DANIEL C MALLORY
Credential	:	D.D.S., M.S.
Telephone Number	:	817-562-3292

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

Similar Medicare Providers

1174830491 — VICTORIA ANNE LOPEZ PT
Practice Location Address:

12650 N BEACH ST STE 150
FORT WORTH, TX
76244-4243

Practice Phone: 817-402-0218
Practice Fax: 844-537-3572

1508151960 — SARATOGA PHARMACY LLC
Practice Location Address:

12650 N BEACH ST STE 112
FORT WORTH, TX
76244-4243

Practice Phone: 817-431-9700
Practice Fax: 817-562-5700

1760933170 — MRS. STEPHANIE CHAMBERS LPC
Practice Location Address:

12650 N BEACH ST STE 114-1000
FORT WORTH, TX
76244-4243

Practice Phone: 817-865-7877
Practice Fax: 817-865-7879

1437684354 — TIMBER CREEK DENTAL & ORTHODONTICS
Practice Location Address:

12650 N BEACH ST , SUITE 100
FORT WORTH, TX
76244-4243

Practice Phone: 817-562-3292
Practice Fax: 817-337-9375

1881159515 — DEVIN LUCAS JOHNSON DPT
Practice Location Address:

12650 N BEACH ST STE 150
FORT WORTH, TX
76244-4243

Practice Phone: 817-402-0218
Practice Fax:

1275099327 — MARIELA AVILA RBT
Practice Location Address:

12650 N BEACH ST STE 145
FORT WORTH, TX
76244-4243

Practice Phone: 682-238-1872
Practice Fax:

Directions to “TIMBER CREEK ORTHODONTICS, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.