MEDICARE: DR. SHEILA BIRTH-ORTHODONTICS-KELLER, LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	14150	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962544395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SHEILA BIRTH-ORTHODONTICS-KELLER, LLC

Provider Business Mailing Address
First Line	:	4420 HERITAGE TRACE PKWY STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8904
Country	:	US
Telephone Number	:	817-348-0910
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 HERITAGE TRACE PKWY STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8904
Country	:	US
Telephone Number	:	817-348-0910
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	SHEILA BIRTH
Credential	:	D. D.S., M.S.
Telephone Number	:	817-348-0910

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/28/2014

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