MEDICARE: AIRLINE DRIVE FAMILY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427718857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRLINE DRIVE FAMILY DENTAL, PLLC

Provider Business Mailing Address
First Line	:	5800 N I 35 STE 205
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-1438
Country	:	US
Telephone Number	:	940-220-7833
Fax Number	:	855-731-5147

Provider Business Practice Location Address
First Line	:	7413 AIRLINE DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-1038
Country	:	US
Telephone Number	:	940-220-7833
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	EVERETT CHAD EVANS
Credential	:	DDS
Telephone Number	:	940-220-7833

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	07/26/2022

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