Broad Park Dental Pa

NPI 1083849707 - Dentist - 1223G0001X

NPI Details
NPI 1083849707
Enumeration Date 05/26/2009
Last Updated 05/26/2009
Entity Type Healthcare Provider
Active Over 7 years ago
Authorized Information
Name JEREMY ISRAEL JEREMY
Position OWNER
Phone (817) 473-6857
Fax (817) 473-3256
Practice Location
1750 E BROAD ST
MANSFIELD TX, 76063-3400, US
Phone (817) 473-6857
Fax (817) 473-3256
Business Location
1750 E BROAD ST
MANSFIELD TX, 76063-3400, US
Phone (817) 473-6857
Fax (817) 473-3256
Toxanomy
Taxonomy Code 1223G0001X
License State Texas
License Number 22486
Remove 1083849707 NPI Number
 

According to our database, Broad Park Dental Pa NPI is 1083849707, taxonomy code is 1223G0001X and license number is 22486, license state is located at Texas. Broad Park Dental Pa physically located at 1750 E Broad St, Mansfield TX, 76063-3400. NPI Number 1033115704 has the healthcare provider type.

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1083849707 NPI number is provided on an as is basis without warranty of any kind. 1083849707 is maintained by the National Plan & Provider Enumeration System. The contents of Broad Park Dental Pa are for informational purposes only.