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2300 Matlock Rd Suite 28 Mansfield TX 76063-5019 | |
| (817) 473-9880 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2300 Matlock Rd, Mansfield, Texas |
| Authorized Official Name and Position | Rick Herrmann (PRESIDENT) |
| Authorized Official Contact | 8174739880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2300 Matlock Rd Suite 28 Mansfield TX 76063-5019 Ph: (817) 473-9880 | 2300 Matlock Rd Suite 28 Mansfield TX 76063-5019 Ph: (817) 473-9880 |
| NPI Number | 1376606673 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376606673 | NPI | - | NPPES |
| 86D839 | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 16967 (Texas) | Primary |
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