Provider Demographics
NPI:1104197680
Name:WORFORD, THERALD F (DDS)
Entity Type:Individual
Prefix:
First Name:THERALD
Middle Name:F
Last Name:WORFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S GOLIAD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3935
Mailing Address - Country:US
Mailing Address - Phone:972-771-9131
Mailing Address - Fax:
Practice Address - Street 1:703 S GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3935
Practice Address - Country:US
Practice Address - Phone:972-771-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice