MEDICARE: DR. KENT HEALY DDS

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	1223P0300X	Periodontics	40411	TN

General Provider Information

NPI Number	:	1528738655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT HEALY DDS

Provider Business Mailing Address
First Line	:	4900 OVERTON RIDGE BLVD STE 213
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 OVERTON RIDGE BLVD STE 213
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1914
Country	:	US
Telephone Number	:	210-844-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	08/28/2024

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Directions to “ DR. KENT HEALY DDS” Practice Location

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