| Fun Dentist-south | |
|
2300 Matlock Road Suite 28 Mansfield TX 76063 | |
| (817) 539-0500 | |
| (817) 539-0505 |
| Full Name | Fun Dentist-south |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2300 Matlock Road, Mansfield, Texas |
| Authorized Official Name and Position | Charles W. Miller (OWNER) |
| Authorized Official Contact | 8174782300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fun Dentist-south 4220 Little Road Arlington TX 76016 Ph: (817) 478-2300 | Fun Dentist-south 2300 Matlock Road Suite 28 Mansfield TX 76063 Ph: (817) 539-0500 |
| NPI Number | 1669779328 |
|---|---|
| Provider Enumeration Date | 02/16/2011 |
| Last Update Date | 09/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669779328 | NPI | - | NPPES |
| 285834201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9223 (Texas) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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