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8113 Camp Bowie West Blvd Benbrook TX 76116-6314 | |
| (817) 560-9300 | |
| (817) 560-9303 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 8113 Camp Bowie West Blvd, Benbrook, Texas |
| Authorized Official Name and Position | Matt A Tyson (PRESIDENT) |
| Authorized Official Contact | 2146759116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8113 Camp Bowie West Blvd Benbrook TX 76116-6314 Ph: (817) 560-9300 | 8113 Camp Bowie West Blvd Benbrook TX 76116-6314 Ph: (817) 560-9300 |
| NPI Number | 1396196481 |
|---|---|
| Provider Enumeration Date | 06/29/2016 |
| Last Update Date | 06/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396196481 | NPI | - | NPPES |
| 1578799250 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 24696 (Texas) | Primary |
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