MEDICARE: CONFI-DENTAL PA

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		TX

General Provider Information

NPI Number	:	1831197664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONFI-DENTAL PA

Provider Business Mailing Address
First Line	:	1401 W BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3814
Country	:	US
Telephone Number	:	817-921-9616
Fax Number	:	817-921-9599

Provider Business Practice Location Address
First Line	:	1401 W BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3814
Country	:	US
Telephone Number	:	817-921-9616
Fax Number	:	817-921-9599

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. ERIC NGOC HUYNH
Credential	:	DDS
Telephone Number	:	817-921-9616

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/21/2022

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