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Organization
LIFETIME AND COSMETIC DENTISTRY
Active
Organization
LIFETIME AND COSMETIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SONYA AUSTIN (OWNER)
(817) 750-5433
Entity
Organization
Contact information
Practice address
5040 N TARRANT PKWY, SUITE 118, FORT WORTH, TX 76244-5389
(817) 750-5433
(817) 750-5431
Mailing address
5040 N TARRANT PKWY, SUITE 118, FORT WORTH, TX 76244-5389
(817) 750-5433
(817) 750-5431
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21381
TX
1223G0001X
General Practice Dentistry
21561
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21381
1223G0001X-DENTIST-GENERAL PRACTISE
TX
01
—
21561
1223G0001X-DENTIST-GENERAL PRACTICE
TX
Enumeration date
01/14/2010
Last updated
01/14/2010
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