Organization
J. TROY BACON DENTISTRY, PLLC
Active
Other names
Del Mar Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON TROY BACON D.D.S. (MANAGER)
(951) 205-5140
Entity
Organization
Contact information
Practice address
6726 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7113
(951) 205-5140
Mailing address
6726 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7113
(951) 205-5140
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24381
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1996837
—
TX
Enumeration date
01/24/2012
Last updated
01/24/2012
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