MEDICARE: ALEX CAMMACK DDS, PLLC

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

General Provider Information

NPI Number	:	1366214033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEX CAMMACK DDS, PLLC

Provider Business Mailing Address
First Line	:	4760 BARWICK DR STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1529
Country	:	US
Telephone Number	:	817-292-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 BARWICK DR STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1529
Country	:	US
Telephone Number	:	817-292-2555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLAY ALEXANDER CAMMACK
Credential	:	DDS
Telephone Number	:	817-292-2555

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	04/04/2024

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