Broad Park Dental PA

NPI #1083849707 in Mansfield, Texas

Provider Information

NPI Number: 1083849707
Entity Type: Organization
Organization Name: Broad Park Dental PA
Primary Specialty: Dentist - General Practice
Enumeration Date: May 26, 2009
Last Updated: May 26, 2009

Practice Location

Address: 1750 E BROAD ST
City: Mansfield
State: Texas
ZIP Code: 76063-3400
Phone: (817) 473-6857

Authorized Official

Name: DR. JEREMY ISRAEL RUDD, DMD
Title: OWNER
Phone: (817) 473-6857

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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