MEDICARE: DULCE DENTAL 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	:	1396274080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DULCE DENTAL PLLC

Provider Business Mailing Address
First Line	:	2906 E BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-4755
Country	:	US
Telephone Number	:	817-289-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 FORT WORTH AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-2421
Country	:	US
Telephone Number	:	817-289-5200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN KUAN
Credential	:
Telephone Number	:	925-324-4152

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/07/2017

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