Organization
FORT WORTH DENTAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN GATLIN BROGDON DDS (OWNER)
(817) 923-4606
Entity
Organization
Contact information
Practice address
3646 GRANBURY RD # 104, FORT WORTH, TX 76109-3717
(817) 923-4606
(817) 923-5593
Mailing address
3646 GRANBURY RD # 104, FORT WORTH, TX 76109-3717
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
17178
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194835215
NPI
—
Enumeration date
01/24/2018
Last updated
01/24/2018
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