MEDICARE: THE HOPE CENTER

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	13790	TX

General Provider Information

NPI Number	:	1518258011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HOPE CENTER

Provider Business Mailing Address
First Line	:	5005 HERITAGE AVE
Second Line	:	SUITE 100
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-5983
Country	:	US
Telephone Number	:	682-738-3029
Fax Number	:	800-618-8507

Provider Business Practice Location Address
First Line	:	3625 E LOOP 820 S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1822
Country	:	US
Telephone Number	:	817-451-6288
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. WILLIAM LAURENCE OLIVER
Credential	:	D.D.S.
Telephone Number	:	682-738-3029

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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Directions to “THE HOPE CENTER ” Practice Location

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