Organization
DENTISTRY FOR CHILDREN OF FORT WORTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JO ANN RICE (CREDENTIALING MANAGER)
(470) 881-8679
Entity
Organization
Contact information
Practice address
5521 BELLAIRE DR S STE 210, FORT WORTH, TX 76109-5900
(817) 569-6633
Mailing address
2970 BRANDYWINE RD STE 200, ATLANTA, GA 30341-5549
(770) 692-1000
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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