| Cc Dental Pc | |
|
1051 Haskell St Ft Worth TX 76107 | |
| (817) 737-8731 | |
| Not Available |
| Full Name | Cc Dental Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1051 Haskell St, Ft Worth, Texas |
| Authorized Official Name and Position | Ty Douglas Shafer (OWNER) |
| Authorized Official Contact | 8177378731 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cc Dental Pc Po Box 93653 Southlake TX 76092-0115 Ph: (817) 737-8731 | Cc Dental Pc 1051 Haskell St Ft Worth TX 76107 Ph: (817) 737-8731 |
| NPI Number | 1851569297 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 02/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851569297 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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