| Fall Creek Dental Pa | |
|
5600 N Gate Rd Suite 103 Granbury TX 76049-3120 | |
| (817) 326-5717 | |
| (817) 326-5714 |
| Full Name | Fall Creek Dental Pa |
|---|---|
| Speciality | Dentist |
| Location | 5600 N Gate Rd, Granbury, Texas |
| Authorized Official Name and Position | Katrina Ladawn Mcfadden (OWNER/DENTIST) |
| Authorized Official Contact | 8173265717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fall Creek Dental Pa 5600 N Gate Rd Suite 103 Granbury TX 76049-3120 Ph: (817) 326-5717 | Fall Creek Dental Pa 5600 N Gate Rd Suite 103 Granbury TX 76049-3120 Ph: (817) 326-5717 |
| NPI Number | 1649544966 |
|---|---|
| Provider Enumeration Date | 03/05/2012 |
| Last Update Date | 03/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649544966 | NPI | - | NPPES |
| 009483101 | Medicaid | TX | |
| B19566 | Other | TX | DELTA DENTAL CHIPS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 19566 (Texas) | Primary |
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