CC DENTAL PC (NPI# 1851569297) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851569297 |
| Entity Type | Organization |
| Organization Name | CC DENTAL PC |
| Practice Address |
1051 Haskell St Ft Worth TX 76107 |
| Mailing Address |
Po Box 93653 Southlake TX 76092-0115 |
| Practice Telephone | 8177378731 |
| Mailing Telephone | 8177378731 |
| Mailing Fax Number | 8177639342 |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2008-02-20 |
| Authorized Official Name | DR. TY DOUGLAS SHAFER (OWNER) |
| Authorized Official Telephone | 8177378731 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
1051 HASKELL ST |
| City | FT WORTH |
| State | TX |
| Zip Code | 76107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669026555 | Dr. Shelby Nelson Dds, LLC | Clinic/Center | 3833 Camp Bowie Blvd, Ft Worth, TX 76107-3355 | 2019-07-29 |
| 1083172456 | Frank T. Hoang Dds, P.a. | Clinic/Center | 5421 Basswood Blvd Ste 770, Ft Worth, TX 76137-4475 | 2019-03-05 |
| 1104847284 | Edward N. Reiter, D.d.s., Inc. | Clinic/Center | 8620 Calmont Ave, Ft Worth, TX 76116-2802 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053587 | David Cheng, Pllc | Clinic/Center | 1708 Spring Green Blvd Ste 195, Katy, TX 77494-7462 | 2020-11-04 |
| 1710587431 | Mysa Dental Pllc | Clinic/Center | 13762 Potranco Rd, Suite 400, San Antonio, TX 78253 | 2020-10-30 |
| 1952901753 | Hq Dental Design | Clinic/Center | 3011 Dawn Dr Ste 105, Georgetown, TX 78628-2827 | 2020-10-29 |
| 1821698788 | All About Smiles Pllc | Clinic/Center | 6420 N Macarthur Blvd Ste 120, Irving, TX 75039-2838 | 2020-10-29 |
| 1659971901 | Qs Dental Partners Pllc | Clinic/Center | 7109 Katy Gaston Road, Suite 400, Richmond, TX 77406 | 2020-10-27 |
| 1154920023 | Deja Opusunju Dmd Pllc | Clinic/Center | 25031 Westheimer Pkwy Ste 200, Katy, TX 77494-7317 | 2020-10-22 |
| 1639776040 | Usck Pllc | Clinic/Center | 7598 N Mesa St Ste 208, El Paso, TX 79912-3521 | 2020-10-08 |
| 1962009373 | Woodforest Dental Loft | Clinic/Center | 2300 Woodforest Pkwy N Ste 700, Montgomery, TX 77316-6503 | 2020-10-08 |
| 1932706173 | Crossway Dental Care Pllc | Clinic/Center | 16616 San Pedro Ave, San Antonio, TX 78232-2223 | 2020-10-01 |
| 1184230302 | Mi Dentista | Clinic/Center | 3101 W Davis St, Dallas, TX 75211-2921 | 2020-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.