1518248590 NPI number — DR BS CHILDRENS DENTISTRY PLLC

Table of content: (NPI 1518248590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518248590 NPI number — DR BS CHILDRENS DENTISTRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR BS CHILDRENS DENTISTRY 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:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518248590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3296 COUNTY ROAD 2134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CADDO MILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75135-6703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-496-6777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3839 PARKER RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYLIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75098-7818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-946-9905
Provider Business Practice Location Address Fax Number:
469-890-2134
Provider Enumeration Date:
09/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BAGGALEY
Authorized Official First Name:
TODD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
702-496-6777

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  S6-107 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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