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Organization
HERITAGE TRACE DENTAL, PA
Active
Organization
HERITAGE TRACE DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT NIELSEN DDS (VICE PRESIDENT)
(817) 741-4288
Entity
Organization
Contact information
Practice address
4160 HERITAGE TRACE PKWY, SUITE 408, KELLER, TX 76248-1312
(817) 741-4288
Mailing address
4160 HERITAGE TRACE PKWY, SUITE 408, KELLER, TX 76248-1313
(817) 741-4288
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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