| NPI | 1962859884 |
|---|---|
| Former Legal Business Name | FORT WORTH MINT DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | FIELD HARRISON CEO 214-821-6468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2019-01-29 |