Organization
EDWARDS RANCH DENTAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA LIGHTFOOT (AUTHORIZED REPRESENTATIVE)
(214) 702-0708
Entity
Organization
Contact information
Practice address
5701 EDWARDS RANCH RD, FORT WORTH, TX 76109-4116
(817) 332-6211
Mailing address
15660 DALLAS PKWY STE 950, DALLAS, TX 75248-3309
(214) 702-0720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/03/2019
Last updated
01/28/2026
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