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Provider Information for 1962560367

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1962560367

Calendar   Last Updated:  2018-01-09
  Certification Date: 


Name Value
NPI 1962560367
Enumeration Date 2006-12-05
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1757 BROAD PARK CIR N STE 101
MANSFIELD, TX 76063-7840
United States

Phone: 682-207-4800 | Fax: 682-207-4800
View Map External Link
Primary Practice Address 101 W DEBBIE LN SUITE 106
MANSFIELD, TX 76063-8937
United States

Phone: 682-518-5200 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice TX 19926