MEDICARE: ENDODONTIC ASSOCIATES OF FORT WORTH, 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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1396234803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC ASSOCIATES OF FORT WORTH, PLLC

Provider Business Mailing Address
First Line	:	1026 E WHEATLAND RD
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-4914
Country	:	US
Telephone Number	:	972-479-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3355
Country	:	US
Telephone Number	:	817-737-3000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. YOGESH PATEL
Credential	:	DDS
Telephone Number	:	214-342-0425

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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