# EDWARDS RANCH DENTAL GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417594946
- **Authorized official:** AMANDA LIGHTFOOT (AUTHORIZED REPRESENTATIVE)
- **Authorized official phone:** (214) 702-0708

## Contact information

- **Practice address:** 5701 EDWARDS RANCH RD, FORT WORTH, TX 76109-4116
- **Practice address phone:** (817) 332-6211
- **Mailing address:** 15660 DALLAS PKWY STE 950, DALLAS, TX 75248-3309
- **Mailing address phone:** (214) 702-0720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2019
- **Last updated:** 01/28/2026