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777 Bandit Trl Suite A Keller TX 76248-0111 | |
| (817) 427-2622 | |
| (817) 427-2625 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 777 Bandit Trl, Keller, Texas |
| Authorized Official Name and Position | Marshall Olson (OWNER/DENTIST) |
| Authorized Official Contact | 8174272622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
777 Bandit Trl Suite A Keller TX 76248-0111 Ph: (817) 427-2622 | 777 Bandit Trl Suite A Keller TX 76248-0111 Ph: (817) 427-2622 |
| NPI Number | 1306284609 |
|---|---|
| Provider Enumeration Date | 06/07/2013 |
| Last Update Date | 12/31/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306284609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 23256 (Texas) | Primary |
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