NPIMap

Organization Active NPI

Lifecycle Dental Resource Inc.

  • General Practice Dentistry
  • Fort Worth, TX
National Provider Identifier
1376934554
Registry record updated Feb 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19529 Issued in TX
Legal business name
LIFECYCLE DENTAL RESOURCE INC.
Practice address
6618 Fossil Bluff Dr
Suite 100
Fort Worth, TX 76137-7533
Phone
(817) 439-8770
NPI assigned
Feb 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2015

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

Authorized official

Name
Tammy Allen
Title
Owner
Phone
(817) 439-8770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19529 TX Primary

Addresses

Primary practice location

6618 Fossil Bluff Dr
Suite 100
Fort Worth, TX 76137-7533

Mailing address

6618 Fossil Bluff Dr
Suite 100
Fort Worth, TX 76137-7533
Phone (817) 439-8770

Other names 1

  • Lifecycle dental Doing business as

National Provider Directory

National Provider Directory

Locations

6618 Fossil Bluff Dr
Ste 100
Fort Worth, TX 76137
Phone (817) 439-8770

NPI Registry JSON

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1376934554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6618 FOSSIL BLUFF DR",
            "address_2": "SUITE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761377533",
            "telephone_number": "817-439-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6618 FOSSIL BLUFF DR",
            "address_2": "SUITE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761377533",
            "telephone_number": "817-439-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECYCLE DENTAL RESOURCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-439-8770"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifecycle dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; 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.