| Organization Name: | COUNTRY DAY DENTAL |
| NPI Number: | 1003186495 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD SCOTT MCDONALD (OWNER/DENTIST) |
| Mailing Address: | 4255 Bryant Irvin Rd Suite 111 Fort Worth |
| State: | TX US |
| Postal Code: | 761094233 |
| Phone Number: | 8177319487 |
| Fax Number: | 8177312846 |
| NPI Enumeration Date: | 01/03/2012 |
| NPI Last Update Date: | 01/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 12997 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |