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NPI Code Detail

MEDICARE: AZTECA DENTAL PLLC

MEDICARE: AZTECA DENTAL 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
11223G0001XGeneral Practice Dentistry
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
3122300000XDentist

General Provider Information

NPI Number : 1235455353
Entity Type Code : Organization
Provider Name (Legal Business Name) : AZTECA DENTAL PLLC
Provider Business Mailing Address
First Line : 4858 SOUTH FWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76115-3901
Country : US
Telephone Number : 817-534-7325
Fax Number : 817-534-4429
Provider Business Practice Location Address
First Line : 4858 SOUTH FWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76115-3901
Country : US
Telephone Number : 817-534-7325
Fax Number : 817-534-4429
Authorized Official
Title or Position : OWNER
Name : DR. HAMID JAY SHAFI
Credential : DDS
Telephone Number : 818-419-5001
Provider Enumeration Date : 04/14/2010
Last Update Date : 04/14/2010

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Directions to “AZTECA DENTAL PLLC ” Practice Location

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