NPI 1306112149

Dental Boat Club P.C

Organisation Preferred Provider Organization Fort Worth, TX

Practice location

Address: 4625 Boat Club Rd STE 225, Fort Worth, TX 76135-7022
Phone: (817) 666-8110
Mailing address: 4625 Boat Club Rd. Suite 225, Fort Worth, TX 75135

Authorised official

Name: Haiduong H Nguyen
Title: Owner
Phone: (213) 862-0106

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 22593 (TX)

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Registry record

NPI: 1306112149
Entity type: Organization
NPI issued: 27 Mar 2012
Record last updated: 27 Mar 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.