Provider Demographics
NPI:1578976064
Name:WEATHERFORD COSMETIC AND FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:WEATHERFORD COSMETIC AND FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-594-3806
Mailing Address - Street 1:114 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4312
Mailing Address - Country:US
Mailing Address - Phone:817-594-3806
Mailing Address - Fax:817-596-5001
Practice Address - Street 1:114 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4312
Practice Address - Country:US
Practice Address - Phone:817-594-3806
Practice Address - Fax:817-596-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7167150001OtherDME PTAN