MEDICARE: TMAA, 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	:	1083098453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMAA, PLLC

Provider Business Mailing Address
First Line	:	4109 BROWN TRAIL
Second Line	:	SUITE 102
City	:	FORT WORTH
State	:	TX
Zip	:	76304-3940
Country	:	US
Telephone Number	:	181-742-8770
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 BROWN TRAIL
Second Line	:	SUITE 102
City	:	FORT WORTH
State	:	TX
Zip	:	76304-3940
Country	:	US
Telephone Number	:	181-742-8770
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	TUONG TA
Credential	:	DDS
Telephone Number	:	817-428-7704

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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