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5421 Basswood Blvd Ste 770 Ft Worth TX 76137-4475 | |
| (817) 577-8831 | |
| (817) 788-8816 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5421 Basswood Blvd Ste 770, Ft Worth, Texas |
| Authorized Official Name and Position | Ashley M Chapa (FRONT OFFICE/ RDA) |
| Authorized Official Contact | 8175778831 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5421 Basswood Blvd Ste 770 Ft Worth TX 76137-4475 Ph: (817) 577-8831 | 5421 Basswood Blvd Ste 770 Ft Worth TX 76137-4475 Ph: (817) 577-8831 |
| NPI Number | 1083172456 |
|---|---|
| Provider Enumeration Date | 03/05/2019 |
| Last Update Date | 05/01/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083172456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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