Wardell Dean III, RPSGT
Individual provider Active NPI Other Technician · Fresno, TX
NPI 1710366109 · NPPES record last updated May 19, 2015
Key facts
- NPI
- 1710366109
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Other Technician 247200000X
- License
- 21356 (TX)
- Practice address
- 4031 E Teal Estates Cir
Fresno, TX 77545-8852 - Phone
- (713) 498-6523
- NPI assigned
- May 19, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21356 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 21356 | TX | Yes |
Addresses
Primary practice location
4031 E Teal Estates Cir
Fresno, TX 77545-8852
Mailing address
4031 E Teal Estates Cir
Fresno, TX 77545-8852
Phone (713) 498-6523
Other providers in Fresno, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.