Provider Demographics
NPI:1942927843
Name:3515 SYCAMORE SCHOOL RD PLLC
Entity Type:Organization
Organization Name:3515 SYCAMORE SCHOOL RD PLLC
Other - Org Name:FRESH SMILES OF FORT WORTH SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-809-4860
Mailing Address - Street 1:2401 E RANDOL MILL RD STE 520
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6380
Mailing Address - Country:US
Mailing Address - Phone:817-809-4860
Mailing Address - Fax:682-626-1824
Practice Address - Street 1:3515 SYCAMORE SCHOOL RD STE 170
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-7823
Practice Address - Country:US
Practice Address - Phone:817-809-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty