MEDICARE: TY DENTAL MEADOWBROOK PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223P0700X	Prosthodontics
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223E0200X	Endodontics
4	122300000X	Dentist
5	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346105392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TY DENTAL MEADOWBROOK PLLC

Provider Business Mailing Address
First Line	:	8150 SPRINGWOOD DR STE 150B
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-5810
Country	:	US
Telephone Number	:	956-507-7253
Fax Number	:

Provider Business Practice Location Address
First Line	:	6302 MEADOWBROOK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5162
Country	:	US
Telephone Number	:	956-507-7253
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIEN PHAN
Credential	:
Telephone Number	:	408-835-3726

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/23/2025

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