Provider Demographics
NPI:1336290758
Name:ACCESS DENTAL OF MCCART
Entity Type:Organization
Organization Name:ACCESS DENTAL OF MCCART
Other - Org Name:ACCESS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-263-8500
Mailing Address - Street 1:6901 MCCART AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6377
Mailing Address - Country:US
Mailing Address - Phone:817-263-8500
Mailing Address - Fax:
Practice Address - Street 1:6901 MCCART AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6377
Practice Address - Country:US
Practice Address - Phone:817-263-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty