NPI: 1417170655 · FORT WORTH, TX 76104 · Oral and Maxillofacial Pathology Dentist · NPI assigned 04/10/2007
| Authorized Official | PORTWOOD, HOLLY (CHIEF OPERATING OFFICER) |
| NPI Enumeration Date | 04/10/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 12 | $134.31 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0140 | Limited oral evaluation - problem focused | 12 | 12 | $134.31 |