Active NPI
Fort Worth Dental
- Dentist
- Fort Worth, TX
National Provider Identifier
1104939024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13209
- Legal business name
- FORT WORTH DENTAL
- Practice address
- 4620 Citylake Blvd W
Fort Worth, TX 76132-3695 - Phone
- (817) 263-0202
- Fax
- (817) 927-7197
- NPI assigned
- Aug 16, 2006
- Last updated
- Oct 11, 2012
- Organization subpart
- Yes
- Parent organization
- ARTHUR J MUND III DDS PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Arthur Jackson Mund III, D.D.S.
- Title
- Owner
- Phone
- (817) 263-0202
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13209 | TX | Primary |
Addresses
Primary practice location
4620 Citylake Blvd W
Fort Worth, TX 76132-3695
Mailing address
4620 Citylake Blvd W
Fort Worth, TX 76132-3695
Phone (817) 263-0202
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 809903 | Other | TX | UNITED CONCORDIA # |
| 25DG | Other | TX | BCBS OF TX PROVIDER # |
| 84D741 | Other | TX | BCBS PROVIDER # |
National Provider Directory
National Provider Directory- Part of
- Fort Worth Dental
Locations
4620 Citylake Blvd W
Fort Worth, TX 76132
Phone (817) 263-0202
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Dentist
- Fort Worth, TX
- NPI 1780797787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1349913600000",
"number": "1104939024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4620 CITYLAKE BLVD W",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761323695",
"telephone_number": "817-263-0202",
"fax_number": "817-927-7197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4620 CITYLAKE BLVD W",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761323695",
"telephone_number": "817-263-0202",
"fax_number": "817-927-7197"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FORT WORTH DENTAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ARTHUR J MUND III DDS PC",
"enumeration_date": "2006-08-16",
"last_updated": "2012-10-11",
"status": "A",
"authorized_official_last_name": "MUND",
"authorized_official_first_name": "ARTHUR",
"authorized_official_middle_name": "JACKSON",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "817-263-0202",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "III",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "TX",
"license": "13209",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA #",
"identifier": "809903",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF TX PROVIDER #",
"identifier": "25DG",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "84D741",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
- Fort Worth Cardiovascular Center, L.P.
- Fort Worth Children's Speech and Feeding Therapy, PLLC
- Fort Worth Chiropractic Clinic PLLC
- Fort Worth Clinic Specialty Care, PLLC
- Fort Worth Cosmetic & Family Dentistry
- Fort Worth Dental Care PLLC
- Fort Worth Dermatology Associates P a
- Fort Worth Dermatology Center, PLLC
- Fort Worth Diagnostic Clinic PA
- Fort Worth Digestive Associates
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.