Tolleson Orthodontics Pllc

NPI #1114358876 in Southlake, Texas

Provider Information

NPI Number: 1114358876
Entity Type: Organization
Organization Name: Tolleson Orthodontics Pllc
Primary Specialty: Dentist
Enumeration Date: Dec 6, 2013
Last Updated: Dec 6, 2013

Practice Location

Address: 1050 E STATE HIGHWAY 114
Address 2: STE 120
City: Southlake
State: Texas
ZIP Code: 76092-5253
Phone: (817) 416-2200

Authorized Official

Name: SHANE TOLLESON
Title: OWNER
Phone: (817) 416-2200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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