is a Periodontology Clinic in Fort Worth, Texas. It is located at 1124 S Lake Street, Suite B, Fort Worth, TX and its contact number is 817-336-1166. The authorized person for is Dwain Edwin Matelski
who is President of the clinic and their contact number is 817-336-1166. The primary license number for is 9930 (Periodontics) in Texas. Clinic is specialized in that branch 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.
Complete Clinic Profile:
Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
Name:
Specialization:
Periodontology
Clinic Address:
1124 S Lake Street, Suite B, Fort Worth, Texas, 76104
Phone:
817-336-1166
Fax:
817-336-1180
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
Name:
Dwain Edwin Matelski
Position:
President
Contact Number:
817-336-1166
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for clinic are as mentioned below.
NPI Number:
1154544740
NPI Enumeration Date:
11 Apr, 2007
NPI Last Update On:
22 Aug, 2020
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for are as mentioned below.
Specialization
License Number
State
Status
Periodontics
9930
Texas
Primary
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
1124 S Lake Street, Suite B Fort Worth, Texas
Zip:
76104
Phone Number:
817-336-1166
Fax Number:
817-336-1180
Patients can reach at 1124 S Lake Street, Suite B, Fort Worth, Texas or can call to book an appointment on 817-336-1166. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 February, 2025.