Individual
DR. CHARLES F ORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS PA
Contact information
Practice address
6380 LBJ, SUITE 199, DALLAS, TX 75240
(972) 991-9891
(972) 991-2747
Mailing address
6380 LBJ, SUITE 199, DALLAS, TX 75240
(972) 991-9891
(972) 991-2747
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
14429
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14429
LICENSE
TX
Enumeration date
08/29/2006
Last updated
07/08/2007
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