Hwy 30 Dental Clinic P a

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20467 Issued in TX

Legal business name

HWY 30 DENTAL CLINIC P A

Practice address

1204 Woodhaven Blvd
Fort Worth, TX 76112

Phone

(817) 654-9760

Fax

(817) 451-8389

NPI assigned

May 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Afkami, DDS

Title

President

Phone

(817) 654-9760

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083836217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 WOODHAVEN BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76112",
            "telephone_number": "817-654-9760",
            "fax_number": "817-451-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 WOODHAVEN BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76112",
            "telephone_number": "817-654-9760",
            "fax_number": "817-451-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HWY 30 DENTAL CLINIC P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AFKAMI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-654-9760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.