| Broad Park Dental Pa | |
|
1750 E Broad St Mansfield TX 76063-3400 | |
| (817) 473-6857 | |
| (817) 473-3256 |
| Full Name | Broad Park Dental Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1750 E Broad St, Mansfield, Texas |
| Authorized Official Name and Position | Jeremy Israel Rudd (OWNER) |
| Authorized Official Contact | 8174736857 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broad Park Dental Pa 1750 E Broad St Mansfield TX 76063-3400 Ph: (817) 473-6857 | Broad Park Dental Pa 1750 E Broad St Mansfield TX 76063-3400 Ph: (817) 473-6857 |
| NPI Number | 1083849707 |
|---|---|
| Provider Enumeration Date | 05/26/2009 |
| Last Update Date | 05/26/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083849707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 22486 (Texas) | Primary |
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