# FAMILY TREE DENTISTRY PA

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

## Provider details

- **NPI number:** 1902073539
- **Authorized official:** DR. DOAN T BUI DDS (DENTIST)
- **Authorized official phone:** (817) 520-0520

## Contact information

- **Practice address:** 8190 PRECINCT LINE STE 200, COLLEYVILLE, TX 76034-7675
- **Practice address phone:** (817) 520-0520
- **Practice address fax:** (817) 520-0525
- **Mailing address:** 8190 PRECINCT LINE STE 200, COLLEYVILLE, TX 76034-7675
- **Mailing address phone:** (817) 520-0520
- **Mailing address fax:** (817) 520-0525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 21783 | TX | Yes |

## Other

- **Enumeration date:** 05/13/2008
- **Last updated:** 05/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 165664704 | MEDICAID | TX |