MEDICARE: DENTISTRY FOR CHILDREN 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	1223P0221X	Pediatric Dentistry	19221	TX

General Provider Information

NPI Number	:	1427222017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY FOR CHILDREN PLLC

Provider Business Mailing Address
First Line	:	1533 MERRIMAC CIR STE 209
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6526
Country	:	US
Telephone Number	:	817-332-0007
Fax Number	:	817-332-0008

Provider Business Practice Location Address
First Line	:	1533 MERRIMAC CIR STE 209
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6526
Country	:	US
Telephone Number	:	817-332-0007
Fax Number	:	817-332-0008

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ISABEL DE ROSAS BRITAIN
Credential	:	D.D.S.
Telephone Number	:	817-332-0007

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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