MEDICARE: IG DENTAL

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1629873708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IG DENTAL

Provider Business Mailing Address
First Line	:	2469 FOREST PARK BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1731
Country	:	US
Telephone Number	:	817-924-6211
Fax Number	:	817-924-6212

Provider Business Practice Location Address
First Line	:	2469 FOREST PARK BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1731
Country	:	US
Telephone Number	:	817-924-6211
Fax Number	:	817-924-6212

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	FAREED IGHANI
Credential	:	D.D.S.
Telephone Number	:	469-766-0906

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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Directions to “IG DENTAL ” Practice Location

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