# EVANGELISTA DENTAL CARE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beyond Smiles Dental,Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841591658
- **Authorized official:** DR. EDWINA JIMENEZ EVANGELISTA DDS (PRESIDENT)
- **Authorized official phone:** (817) 232-4600

## Contact information

- **Practice address:** 6600 NORTH FWY STE 109, FORT WORTH, TX 76137-7556
- **Practice address phone:** (817) 232-4600
- **Practice address fax:** (817) 232-4610
- **Mailing address:** 6600 NORTH FWY STE 109, FORT WORTH, TX 76137-7556
- **Mailing address phone:** (817) 232-4600
- **Mailing address fax:** (817) 232-4610

## Taxonomy

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

## Other

- **Enumeration date:** 11/10/2010
- **Last updated:** 11/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1992914758 | — | TX |