MEDICARE: BEAR CREEK FAMILY DENTISTRY, PA

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	:	1457705303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR CREEK FAMILY DENTISTRY, PA

Provider Business Mailing Address
First Line	:	PO BOX 541447
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75354-1447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 E BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-5053
Country	:	US
Telephone Number	:	817-535-8200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT E TAFEL
Credential	:	D.D.S.
Telephone Number	:	817-535-8200

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	04/18/2016

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