MEDICARE: DRS. BIRTH & STEWART-ORTHODONTICS-FT WORTH, LLC

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	14150	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073673224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. BIRTH & STEWART-ORTHODONTICS-FT WORTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 330874
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76163-0874
Country	:	US
Telephone Number	:	817-370-0268
Fax Number	:	817-263-9217

Provider Business Practice Location Address
First Line	:	3060 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7771
Country	:	US
Telephone Number	:	817-370-0268
Fax Number	:	817-263-9217

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. SHEILA T. BIRTH
Credential	:	DDS, MS
Telephone Number	:	817-370-0268

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/12/2008

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