1St Dental & Orthodontics

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

1ST DENTAL & ORTHODONTICS

Practice address

5540 Sycamore School Rd Ste 324
Fort Worth, TX 76123-3060

Phone

(817) 725-7500

NPI assigned

Nov 1, 2021

Organization subpart

No

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

Authorized official

Name

Omar Fetouh, DDS

Title

Owner

Phone

(716) 348-9855

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1740945260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5540 SYCAMORE SCHOOL RD STE 324",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761233060",
            "telephone_number": "817-725-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5540 SYCAMORE SCHOOL RD STE 324",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761233060",
            "telephone_number": "817-725-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST DENTAL & ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "FETOUH",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-348-9855",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.