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Organization
COWTOWN DENTAL
Active
Organization
COWTOWN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAYTON KELLER (MANAGING MEMBER)
(402) 216-9318
Entity
Organization
Contact information
Practice address
4930 CAMP BOWIE BLVD, FORT WORTH, TX 76107-4153
(817) 735-4555
Mailing address
4930 CAMP BOWIE BLVD, FORT WORTH, TX 76107-4153
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/21/2022
Last updated
07/21/2022
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