MEDICARE: DR. JOSEPH S. MCCREARY DDS

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	1223G0001X	General Practice Dentistry	6607	TX

General Provider Information

NPI Number	:	1255337374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH S. MCCREARY DDS

Provider Business Mailing Address
First Line	:	13160 MILLER RD
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-5702
Country	:	US
Telephone Number	:	817-444-4355
Fax Number	:

Provider Business Practice Location Address
First Line	:	6013 WEDGWOOD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2728
Country	:	US
Telephone Number	:	817-292-1442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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