DR. STEPHEN GATLIN BROGDON DDS NPI 1194835215

NPI Information

  • NPI: 1194835215
  • Provider Name: DR. STEPHEN GATLIN BROGDON, DDS
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3646 GRANBURY RD
    SUITE 104
    FORT WORTH, TX
    ZIP 76109
  • Phone: (817) 923-4606

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NPI Details

DR. Stephen Gatlin Brogdon, DDS is a general practice dentist in Fort Worth, TX. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Stephen Gatlin Brogdon, DDS NPI is 1194835215. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3646 GRANBURY RD
SUITE 104
FORT WORTH, TX
ZIP 76109-717
Phone: (817) 923-4606
Fax: (817) 923-5593

The NPI 1194835215 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 8/30/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice17178TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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