| Dwain E Matelski Dds Periodontist | |
|
1124 S Lake Street Suite B Fort Worth TX 76104 | |
| (817) 336-1166 | |
| (817) 336-1180 |
| Full Name | Dwain E Matelski Dds Periodontist |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1124 S Lake Street, Fort Worth, Texas |
| Authorized Official Name and Position | Dwain Edwin Matelski (PRESIDENT) |
| Authorized Official Contact | 8173361166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dwain E Matelski Dds Periodontist 1124 S Lake Street Suite B Fort Worth TX 76104 Ph: (817) 336-1166 | Dwain E Matelski Dds Periodontist 1124 S Lake Street Suite B Fort Worth TX 76104 Ph: (817) 336-1166 |
| NPI Number | 1154544740 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154544740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 9930 (Texas) | Primary |
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