MEDICARE: DENTISTS AT CHISHOLM TRAIL, PC

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

General Provider Information

NPI Number	:	1770118911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS AT CHISHOLM TRAIL, PC

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	9604 TEN GALLON DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2186
Country	:	US
Telephone Number	:	817-803-4362
Fax Number	:	817-803-4090

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOYANNA HOFFMAN
Credential	:	DMD
Telephone Number	:	817-803-4362

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	06/14/2022

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