Provider Demographics
NPI:1871146845
Name:DENTAL ASSOCIATES OF FORT WORTH
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF FORT WORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:SANTILLANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-924-7670
Mailing Address - Street 1:1505 BIRCHMONT LN
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8210
Mailing Address - Country:US
Mailing Address - Phone:817-924-7670
Mailing Address - Fax:817-924-7670
Practice Address - Street 1:3548 S HILLS AVE STE 17
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2838
Practice Address - Country:US
Practice Address - Phone:817-924-7670
Practice Address - Fax:817-924-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice