1407256233 NPI number — HURST CITY FAMILY AND COSMETIC DENTISTRY

Table of content: (NPI 1407256233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407256233 NPI number — HURST CITY FAMILY AND COSMETIC DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HURST CITY FAMILY AND COSMETIC DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407256233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 REEVES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76234-3855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-627-8400
Provider Business Mailing Address Fax Number:
940-627-8402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 W HARWOOD RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76054-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-369-3290
Provider Business Practice Location Address Fax Number:
817-369-3292
Provider Enumeration Date:
08/28/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NWOKORIE
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
UMUNNA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
347-439-8901

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  25799 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 215320712 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".