Michael Ross Drennan, DDS
Individual provider Active NPI Dentist · Willow Park, TX
NPI 1790985513 · NPPES record last updated Jan 24, 2019
Key facts
- NPI
- 1790985513
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 23408 (TX)
- Practice address
- 220 Shops Blvd
Willow Park, TX 76087-4375 - Phone
- (817) 441-7654
- Fax
- (817) 441-6168
- NPI assigned
- Jul 19, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150514000984 | TX | Order and Referring Only - Oral Surgery |
6709106792 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23408 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crown Pointe Dentistry, PA | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 23408 | TX | Yes |
Addresses
Primary practice location
220 Shops Blvd
Willow Park, TX 76087-4375
Mailing address
220 Shops Blvd
Willow Park, TX 76087
Phone (817) 441-7654
Other providers in Willow Park, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.