MEDICARE: DENTISTRY BY DESIGN 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

General Provider Information

NPI Number	:	1841551421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY BY DESIGN PA

Provider Business Mailing Address
First Line	:	3013 E RENNER RD STE 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3577
Country	:	US
Telephone Number	:	972-231-3013
Fax Number	:

Provider Business Practice Location Address
First Line	:	3013 E RENNER RD STE 100
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3577
Country	:	US
Telephone Number	:	972-231-3013
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BRADFORD TINER
Credential	:	DMD
Telephone Number	:	972-231-3013

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	07/23/2024

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