NPI 1740569144 · live from the CMS NPI Registry
Abc123 Dental In Haltom PLLC
Dentist in Fort Worth, TX. National Provider Identifier 1740569144, active.
NPI record
| NPI | 1740569144 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 5416 Basswood Blvd, Fort Worth, TX 76137 |
| Practice phone | 817-656-1215 |
| Enumerated | August 16, 2011 |
| Last updated | August 16, 2011 |
| Authorized official | Tri Pham, Owner/Dentist |
| Other names | Abc123 Dental |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | 24570 (TX) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.