Fort Worth Dental Care PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

17178 Issued in TX

Legal business name

FORT WORTH DENTAL CARE PLLC

Practice address

3646 Granbury Rd # 104
Fort Worth, TX 76109-3717

Phone

(817) 923-4606

Fax

(817) 923-5593

NPI assigned

Jan 24, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Gatlin Brogdon, DDS

Title

Owner

Phone

(817) 923-4606

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1972001048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3646 GRANBURY RD # 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761093717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3646 GRANBURY RD # 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761093717",
            "telephone_number": "817-923-4606",
            "fax_number": "817-923-5593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH DENTAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "BROGDON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "GATLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-923-4606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "17178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1194835215",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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
• Fort Worth Dermatology Associates P a
• Fort Worth Dermatology Center, PLLC
• Fort Worth Diagnostic Clinic PA
• Fort Worth Digestive Associates
• Fort Worth Emergency Dental Care PC

• Dental Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; 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.