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Organization
NCD,PA
Active
Organization
NCD,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI TIPPETT (OFFICE MANAGER)
(817) 581-2100
Entity
Organization
Contact information
Practice address
7748 DENTON HWY, WATAUGA, TX 76148-2463
(817) 581-2100
Mailing address
7748 DENTON HWY, WATAUGA, TX 76148-2463
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12638
TX
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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