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NPI Code Detail

MEDICARE: AFFORDABLE DENTIST NEAR ME LAKEWORTH PLLC

MEDICARE: AFFORDABLE DENTIST NEAR ME LAKEWORTH PLLC
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
1122300000XDentist

General Provider Information

NPI Number : 1982411310
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFFORDABLE DENTIST NEAR ME LAKEWORTH PLLC
Provider Business Mailing Address
First Line : 1966 EPHRIHAM AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-6670
Country : US
Telephone Number : 214-226-7546
Fax Number :
Provider Business Practice Location Address
First Line : 1966 EPHRIHAM AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-6670
Country : US
Telephone Number : 214-226-7546
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : CINTIA RODAWAY
Credential :
Telephone Number : 903-441-1558
Provider Enumeration Date : 12/18/2024
Last Update Date : 12/18/2024

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Directions to “AFFORDABLE DENTIST NEAR ME LAKEWORTH PLLC ” Practice Location

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