Southlake Dental Corp 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 Southlake Dental Corp is Dwain Edwin Matelski
who is President of the clinic and their contact number is 817-336-1166. The primary license number for Southlake Dental Corp is 9930 (Periodontics) in Texas.
Southlake Dental Corp 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:
Southlake Dental Corp Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Southlake Dental Corp |
| 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 Southlake Dental Corp 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 Southlake Dental Corp 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: | Southlake Dental Corp
1124 S Lake Street, Suite B
Fort Worth, Texas |
| Zip: | 76104 |
| Phone Number: | 817-336-1166 |
| Fax Number: | 817-336-1180 |
Patients can reach Southlake Dental Corp at
1124 S Lake Street, Suite B, Fort Worth, Texas or can
call to book an appointment on 817-336-1166.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
09 March, 2026.