MEDICARE: DRS. BIRTH & FLETCHER -ORTHODONTICS, P.L.L.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		TX

General Provider Information

NPI Number	:	1356683338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. BIRTH & FLETCHER -ORTHODONTICS, P.L.L.C.

Provider Business Mailing Address
First Line	:	4420 HERITAGE TRACE PKWY STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8904
Country	:	US
Telephone Number	:	817-479-0541
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 HERITAGE TRACE PKWY STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8904
Country	:	US
Telephone Number	:	817-479-0541
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. CRISTI FLETCHER
Credential	:	DDS MS
Telephone Number	:	817-348-0910

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	04/09/2014

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