| NPI | 1386052751 |
|---|---|
| Doing Business As | PROSPER DENTISTRY AND ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | THOMAS RUSSELL CHANDLER Dentist 817-681-4580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21656) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 20894) |
| 1223P0300X Dentist, Periodontics (Licence: TX 21239) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 18320) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-07-29 |