Provider Demographics
NPI:1770729386
Name:ACCESS DENTAL OF MEADOWBROOK
Entity type:Organization
Organization Name:ACCESS DENTAL OF MEADOWBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
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:214-678-9200
Mailing Address - Street 1:6302 MEADOWBROOK DR
Mailing Address - Street 2:SUITE #112
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-5121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6302 MEADOWBROOK DR
Practice Address - Street 2:SUITE #112
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-5121
Practice Address - Country:US
Practice Address - Phone:214-678-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty