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Organization
MINI APPLE DENTAL ENTERPRISE PLLC
Active
Organization
MINI APPLE DENTAL ENTERPRISE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB SISOMBATH DDS (OWNER)
(612) 735-3712
Entity
Organization
Contact information
Practice address
911 N SYLVANIA AVE, #150, FORT WORTH, TX 76111
(612) 735-3712
(972) 329-7005
Mailing address
911 N SYLVANIA AVE, SUITE #150, FORT WORTH, TX 76111-2459
(612) 735-3712
(972) 329-7000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25064
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25064
LICENSE
TX
Enumeration date
06/25/2015
Last updated
07/02/2015
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