Provider Demographics
NPI:1982921060
Name:NAVARRO ORTHODONTICS OF FORTWORTH,
Entity Type:Organization
Organization Name:NAVARRO ORTHODONTICS OF FORTWORTH,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:214-526-3363
Mailing Address - Street 1:4514 COLE AVE STE 910
Mailing Address - Street 2:SUITE A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:214-526-3363
Mailing Address - Fax:214-520-7753
Practice Address - Street 1:815 E BERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:FORTWORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4414
Practice Address - Country:US
Practice Address - Phone:817-916-5820
Practice Address - Fax:817-916-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216878301Medicaid