Organization
FALL CREEK DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATRINA LADAWN MCFADDEN D.D.S. (OWNER/DENTIST)
(817) 326-5717
Entity
Organization
Contact information
Practice address
5600 N GATE RD, SUITE 103, GRANBURY, TX 76049-3120
(817) 326-5717
(817) 326-5714
Mailing address
5600 N GATE RD, SUITE 103, GRANBURY, TX 76049-3120
(817) 326-5717
(817) 326-5714
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19566
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009483101
—
TX
01
—
B19566
DELTA DENTAL CHIPS
TX
Enumeration date
03/05/2012
Last updated
03/05/2012
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