1528230331 NPI number — DENTON PEDIATRIC PHYSICIANS PLLC

Table of content: (NPI 1528230331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528230331 NPI number — DENTON PEDIATRIC PHYSICIANS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTON PEDIATRIC PHYSICIANS 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:
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:
1528230331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3537 S I-35 E
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-565-1222
Provider Business Mailing Address Fax Number:
940-565-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3537 S I-35 E
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-565-1222
Provider Business Practice Location Address Fax Number:
940-565-1220
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-401-8720

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0003RH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 194449801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com