| Southlake Dental Care, PA | |
|
500 W Southlake Blvd Ste 130 Southlake TX 76092-6165 | |
| (817) 310-0310 | |
| (817) 310-0909 |
| Full Name | Southlake Dental Care, PA |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 500 W Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Todd Gathright (PRESIDENT) |
| Authorized Official Contact | 8179919478 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Dental Care, PA 500 W Southlake Blvd Ste 130 Southlake TX 76092-6165 Ph: (817) 310-0310 | Southlake Dental Care, PA 500 W Southlake Blvd Ste 130 Southlake TX 76092-6165 Ph: (817) 310-0310 |
| NPI Number | 1477721728 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 02/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477721728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20397 (Texas) | Primary |
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