Provider Demographics
NPI:1902967425
Name:POWELL, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:PEAKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:650 INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6612
Mailing Address - Country:US
Mailing Address - Phone:817-238-7984
Mailing Address - Fax:
Practice Address - Street 1:6628 LAKE WORTH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3018
Practice Address - Country:US
Practice Address - Phone:817-238-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice