FORT WORTH DENTAL CARE PLLC (NPI# 1972001048) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972001048 |
| Entity Type | Organization |
| Organization Name | FORT WORTH DENTAL CARE PLLC |
| Practice Address |
3646 Granbury Rd # 104 Fort Worth TX 76109-3717 |
| Practice Telephone | 8179234606 |
| Practice Fax Number | 8179235593 |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-01-24 |
| Authorized Official Name | DR. STEPHEN GATLIN BROGDON (OWNER) |
| Authorized Official Telephone | 8179234606 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
17178 | TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI | 1194835215 | 01 |
| Street Address |
3646 GRANBURY RD # 104 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76109-3717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881156164 | Elizabeth Laborde Dds Pllc | Clinic/Center | 5656 Edwards Ranch Rd, Fort Worth, TX 76109 | 2019-04-04 |
| 1992273965 | Debra Cooper Lantz | Occupational Therapist | 4252 Bryant Irvin Road, Fort Worth, TX 76109 | 2018-11-08 |
| 1417434119 | Dermatology Specialists of Fort Worth Pllc | Dermatology | 6100 Southwest Blvd., Suite 100, Fort Worth, TX 76109 | 2018-07-25 |
| 1417446709 | Eating Recovery Center of Texas, LLC | Clinic/Center | 4200 S. Hulen Street, Suite #436, Ft. Worth, TX 76109 | 2018-05-02 |
| 1245751742 | Marissa Izabel San Miguel | Optometrist | 5912 Convair Dr Ste 208, Fort Worth, TX 76109 | 2017-07-05 |
| 1174910111 | Parkway Dental Professionals | Preferred Provider Organization | 4200 Bryant Irvin Rd. Ste. 101, Fort Worth, TX 76109 | 2015-04-16 |
| 1831583095 | Deborah K Lehmann, M.d. | Clinic/Center | 6420 Southwest Blvd., #128, Fort Worth, TX 76109 | 2015-03-26 |
| 1184036428 | Ft Worth Ranch Assist, LLC | Neurological Surgery | 3516 Ranch View Terrace, Fort Worth, TX 76109 | 2014-05-21 |
| 1821435538 | Metx LLC | Hearing Instrument Specialist | 4618 Sw Loop 820, Fort Worth, TX 76109 | 2013-06-04 |
| 1356608087 | Virginia Flores | Social Worker | 4208 Ranier Ct, Fort Worth, TX 76109 | 2012-04-19 |
| Find all providers in zip 76109 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750933115 | Smiles of Fort Worth, LLC | Clinic/Center | 5601 Bridge St Ste 480, Fort Worth, TX 76112-2351 | 2019-07-15 |
| 1881156164 | Elizabeth Laborde Dds Pllc | Clinic/Center | 5656 Edwards Ranch Rd, Fort Worth, TX 76109 | 2019-04-04 |
| 1710460688 | Reliable Dentistry Pllc | Clinic/Center | 5228 Sycamore School Road, #108, Fort Worth, TX 76123-7612 | 2018-09-07 |
| 1023526365 | J&l Dental Group, Pllc | Clinic/Center | 2401 Heritage Trace Parkway, Suite 121, Fort Worth, TX 76177 | 2018-01-22 |
| 1871002261 | Smile Ninja, Pllc | Clinic/Center | 220 E Seminary Dr Ste 100, Fort Worth, TX 76115-2653 | 2017-09-28 |
| 1538689799 | Mini Joseph Dds Pllc | Clinic/Center | 2977 South Precinct Line Road, Suite 213, Fort Worth, TX 76118-7611 | 2017-06-20 |
| 1578010179 | Mint Dentistry, Pllc | Clinic/Center | 2700 Horne Street, Suite 120, Fort Worth, TX 76107 | 2016-09-01 |
| 1962859884 | Mint Dentistry, Pllc | Clinic/Center | 3829 E Loop 820 S, Fort Worth, TX 76119-4339 | 2016-05-20 |
| 1013382001 | Brown Family Dentistry | Clinic/Center | 4004 White Settlement Rd, Fort Worth, TX 76107-1162 | 2015-12-02 |
| 1952748295 | Dr. Christopher Kim, Dds, Pa | Clinic/Center | 8455 Boat Club Rd, Suite 175, Fort Worth, TX 76179-3632 | 2013-05-28 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76109 |
Please comment or provide details below to improve the information on FORT WORTH DENTAL CARE PLLC.
| 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.