MEDICARE: FOREVER TEETH P.L.L.C.

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	20521	TX

General Provider Information

NPI Number	:	1477758233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER TEETH P.L.L.C.

Provider Business Mailing Address
First Line	:	112 INDUSTRIAL AVE
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-2934
Country	:	US
Telephone Number	:	817-270-3700
Fax Number	:	817-270-3711

Provider Business Practice Location Address
First Line	:	112 INDUSTRIAL AVE
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-2934
Country	:	US
Telephone Number	:	817-270-3700
Fax Number	:	817-270-3711

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. TRAN BAO DANG
Credential	:	DDS
Telephone Number	:	817-270-3700

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	09/27/2013

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