MEDICARE: DAV ROW ENTERPRISES

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	122300000X	Dentist	25817	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538476858	OTHER		NPI

General Provider Information

NPI Number	:	1619366572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAV ROW ENTERPRISES

Provider Business Mailing Address
First Line	:	6263 MCCART AVE
Second Line	:	200
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4200
Country	:	US
Telephone Number	:	817-370-1314
Fax Number	:	817-370-1344

Provider Business Practice Location Address
First Line	:	6263 MCCART AVE
Second Line	:	200
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4200
Country	:	US
Telephone Number	:	817-370-1314
Fax Number	:	817-370-1344

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MICHELLE DAVILA
Credential	:	DDS
Telephone Number	:	817-370-1314

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “DAV ROW ENTERPRISES ” Practice Location

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