MEDICARE: STAFFORD FAMILY ENTERPRISES

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	23931	TX

General Provider Information

NPI Number	:	1295272045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAFFORD FAMILY ENTERPRISES

Provider Business Mailing Address
First Line	:	3704 W. CAMPWISDOM RD. STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237
Country	:	US
Telephone Number	:	972-709-8482
Fax Number	:	214-594-7850

Provider Business Practice Location Address
First Line	:	3704 W. CAMPWISDOM RD. STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237
Country	:	US
Telephone Number	:	972-709-8482
Fax Number	:	214-594-7850

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAOSAT MARIA STAFFORD
Credential	:	DDS
Telephone Number	:	972-709-8482

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	03/26/2022

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