# CC DENTAL PC

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

## Provider details

- **NPI number:** 1851569297
- **Authorized official:** DR. TY DOUGLAS SHAFER DDS (OWNER)
- **Authorized official phone:** (817) 737-8731

## Contact information

- **Practice address:** 1051 HASKELL ST, FT WORTH, TX 76107
- **Practice address phone:** (817) 737-8731
- **Mailing address:** PO BOX 93653, SOUTHLAKE, TX 76092-0115
- **Mailing address phone:** (817) 737-8731
- **Mailing address fax:** (817) 763-9342

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/20/2008
- **Last updated:** 02/20/2008