Organization
CC DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TY DOUGLAS SHAFER DDS (OWNER)
(817) 737-8731
Entity
Organization
Contact information
Practice address
1051 HASKELL ST, FT WORTH, TX 76107
(817) 737-8731
Mailing address
PO BOX 93653, SOUTHLAKE, TX 76092-0115
(817) 737-8731
(817) 763-9342
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/20/2008
Last updated
02/20/2008
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