Dentistry For Children Of Fort Worth PLLC
Dentist, Pediatric Dentistry in Fort Worth, TX. Organization (NPI-2).
NPI number1720705387
StatusActive
Last updated in NPPESOct 25, 2022
Details
- NPI
- 1720705387
- Entity type
- Organization (NPI-2)
- Legal business name
- Dentistry For Children Of Fort Worth PLLC
- Organization subpart
- No
- Enumeration date
- Oct 25, 2022
- Certification date
- Oct 25, 2022
- Last updated
- Oct 25, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | – | – | Yes |
| 261QD0000X | Clinic/Center, Dental | – | – |
Practice location
5521 Bellaire Dr S Ste 210Fort Worth, TX 76109-5900
Phone 817-569-6633
Mailing address
2970 Brandywine Rd Ste 200Atlanta, GA 30341-5549
Phone 770-692-1000
Authorized official
Jo Ann Rice
Credentialing Manager
4708818679
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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