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NPI Code Detail

MEDICARE: DR. JAMES RALPH MACHOLL DDS, M.D.

MEDICARE:  DR. JAMES RALPH MACHOLL  DDS, M.D.
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
11223S0112XOral and Maxillofacial Surgery (Dentist)29872TX

General Provider Information

NPI Number : 1326155854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES RALPH MACHOLL DDS, M.D.
Provider Business Mailing Address
First Line : 9415 N BEACH ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-9059
Country : US
Telephone Number : 817-741-2200
Fax Number : 817-741-2216
Provider Business Practice Location Address
First Line : 9415 N BEACH ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-9059
Country : US
Telephone Number : 817-741-2200
Fax Number : 817-741-2216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 03/08/2021

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