# FORT WORTH DENTAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ARTHUR J MUND III DDS PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104939024
- **Legal business name:** ARTHUR J MUND III DDS PC
- **Authorized official:** DR. ARTHUR JACKSON MUND III D.D.S. (OWNER)
- **Authorized official phone:** (817) 263-0202

## Contact information

- **Practice address:** 4620 CITYLAKE BLVD W, FORT WORTH, TX 76132-3695
- **Practice address phone:** (817) 263-0202
- **Practice address fax:** (817) 927-7197
- **Mailing address:** 4620 CITYLAKE BLVD W, FORT WORTH, TX 76132-3695
- **Mailing address phone:** (817) 263-0202
- **Mailing address fax:** (817) 927-7197

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 13209 | TX | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 10/11/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 25DG | BCBS OF TX PROVIDER \# | TX |
| 01 | — | 809903 | UNITED CONCORDIA \# | TX |
| 01 | — | 84D741 | BCBS PROVIDER \# | TX |