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Southlake Dental Corp
Periodontist in Fort Worth, Texas
NPI 1154544740

Southlake Dental Corp is a Periodontist based in Fort Worth, TX and is specialized in Periodontics. Southlake Dental Corp practices in Fort Worth, TX. The NPI Number for Southlake Dental Corp is 1154544740 and holds a License No. 9930 (Texas).

The current practice location address for Southlake Dental Corp is 1124 S Lake Street, Fort Worth, TX and can be reached out via phone at 817-336-1166 and via fax at 817-336-1180.

Location: 1124 S Lake Street, Fort Worth, TX, 76104
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1154544740
Provider Name
Southlake Dental Corp
Credential
Provider Entity Type
Organization
Address
1124 S Lake Street, Fort Worth, TX, 76104
Phone Number
817-336-1166
Fax Number
817-336-1180
Provider Enumeration Date
04/11/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1124 S Lake Street
City
Fort Worth
State
Texas
Zip
76104
Phone Number
817-336-1166
Fax Number
817-336-1180
person
Provider Business Mailing Address Details
Address
1124 S Lake Street
City
Fort Worth
State
Texas
Zip
76104
Phone Number
817-336-1166
Fax Number
817-336-1180
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Periodontics
Taxonomy
1223P0300X
License No.
9930 (Texas)
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
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