Provider Demographics
NPI:1609274026
Name:NATIONAL DENTAL SERVICES- NDS DENTAL
Entity Type:Organization
Organization Name:NATIONAL DENTAL SERVICES- NDS DENTAL
Other - Org Name:NDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-920-7569
Mailing Address - Street 1:3740 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3700
Mailing Address - Country:US
Mailing Address - Phone:817-920-7569
Mailing Address - Fax:
Practice Address - Street 1:8701 REGAL ROYALE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-7948
Practice Address - Country:US
Practice Address - Phone:817-920-7569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty