Southlake Dental Corp
Southlake Dental Corp provides Periodontics in Fort Worth, Texas. Licensed in Texas. Registered with an NPI since 2007.
- Licensed in
- TX
- In the registry since
- 2007
What do these letters mean?
- Corp — Corporation
- A form of business registration, not a clinical qualification.
Practice location Address checks out
1124 S Lake St Ste BFort Worth, TX 76104
Phone: (817) 336-1166
Fax: (817) 336-1180
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Periodontics (primary) | Taxonomy 1223P0300X · Licence 9930 (TX) |
|---|
Record details
| NPI number | 1154544740 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Dwain Matelski — President · (817) 336-1166 |
| Other names | Dwain E Matelski Dds Periodontist |
| NPI enumerated | April 11, 2007 |
| Last updated in NPPES | August 22, 2020 |
| Mailing address | 1124 S Lake Street, Suite B, Fort Worth, TX 76104 |
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