MEDICARE: MCCART DENTAL PLAZA 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	122300000X	Dentist	21714	TX

General Provider Information

NPI Number	:	1891063871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCART DENTAL PLAZA PC

Provider Business Mailing Address
First Line	:	7664 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7803
Country	:	US
Telephone Number	:	817-346-9700
Fax Number	:	817-346-9708

Provider Business Practice Location Address
First Line	:	7664 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7803
Country	:	US
Telephone Number	:	817-346-9700
Fax Number	:	817-346-9708

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. HAMID FARAHANI
Credential	:	DDS
Telephone Number	:	817-346-9700

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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