1649560590 NPI number — ABC PEDIATRIC DENTAL CENTER PLLC

Table of content: (NPI 1649560590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649560590 NPI number — ABC PEDIATRIC DENTAL CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC PEDIATRIC DENTAL CENTER PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1649560590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 HEBRON PKWY STE 201
Provider Second Line Business Mailing Address:
ATTN. DR. KENDRA BEHRAM
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-5143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-645-5940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 HEBRON PKWY STE 330
Provider Second Line Business Practice Location Address:
ATTN. DR. KENDRA BEHRAM
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75057-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-645-5940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BEHRAM
Authorized Official First Name:
KENDRA UGO
Authorized Official Middle Name:
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
240-645-5940

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  026115 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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