Organization
EVANGELISTA DENTAL CARE, PLLC
Active
Other names
Beyond Smiles Dental,Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWINA JIMENEZ EVANGELISTA DDS (PRESIDENT)
(817) 232-4600
Entity
Organization
Contact information
Practice address
6600 NORTH FWY STE 109, FORT WORTH, TX 76137-7556
(817) 232-4600
(817) 232-4610
Mailing address
6600 NORTH FWY STE 109, FORT WORTH, TX 76137-7556
(817) 232-4600
(817) 232-4610
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992914758
—
TX
Enumeration date
11/10/2010
Last updated
11/10/2010
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