MEDICARE: TITAN DENTAL 3 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	122300000X	Dentist

General Provider Information

NPI Number	:	1235565979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TITAN DENTAL 3 PLLC

Provider Business Mailing Address
First Line	:	6204 S COOPER ST
Second Line	:	STE. 104
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5700
Country	:	US
Telephone Number	:	972-841-2305
Fax Number	:

Provider Business Practice Location Address
First Line	:	6204 S COOPER ST
Second Line	:	STE. 104
City	:	ARLINGTON
State	:	TX
Zip	:	76001
Country	:	US
Telephone Number	:	214-766-4205
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	MELISSA HERNANDEZ
Credential	:
Telephone Number	:	469-803-0014

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	08/01/2024

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