# FALL CREEK DENTAL PA

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

## Provider details

- **NPI number:** 1649544966
- **Authorized official:** DR. KATRINA LADAWN MCFADDEN D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (817) 326-5717

## Contact information

- **Practice address:** 5600 N GATE RD, SUITE 103, GRANBURY, TX 76049-3120
- **Practice address phone:** (817) 326-5717
- **Practice address fax:** (817) 326-5714
- **Mailing address:** 5600 N GATE RD, SUITE 103, GRANBURY, TX 76049-3120
- **Mailing address phone:** (817) 326-5717
- **Mailing address fax:** (817) 326-5714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 19566 | TX | Yes |

## Other

- **Enumeration date:** 03/05/2012
- **Last updated:** 03/05/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 009483101 | — | TX |
| 01 | — | B19566 | DELTA DENTAL CHIPS | TX |