| Mini Apple Dental Enterprise Pllc | |
|
911 N Sylvania Ave #150 Fort Worth TX 76111 | |
| (612) 735-3712 | |
| (972) 329-7005 |
| Full Name | Mini Apple Dental Enterprise Pllc |
|---|---|
| Speciality | Dentist |
| Location | 911 N Sylvania Ave, Fort Worth, Texas |
| Authorized Official Name and Position | Jacob Sisombath (OWNER) |
| Authorized Official Contact | 6127353712 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mini Apple Dental Enterprise Pllc 911 N Sylvania Ave Suite #150 Fort Worth TX 76111-2459 Ph: (612) 735-3712 | Mini Apple Dental Enterprise Pllc 911 N Sylvania Ave #150 Fort Worth TX 76111 Ph: (612) 735-3712 |
| NPI Number | 1851773857 |
|---|---|
| Provider Enumeration Date | 06/25/2015 |
| Last Update Date | 07/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851773857 | NPI | - | NPPES |
| 25064 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 25064 (Texas) | Primary |
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