1821425430 NPI number — CHILDREN 1ST HOUSTON WEST, LLC

Table of content: (NPI 1821425430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821425430 NPI number — CHILDREN 1ST HOUSTON WEST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN 1ST HOUSTON WEST, LLC
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:
CHILDREN 1ST DENTAL & SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1821425430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3055 BARDIN RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75052-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-412-1500
Provider Business Mailing Address Fax Number:
214-412-1510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 S GESSNER DR. SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-412-1500
Provider Business Practice Location Address Fax Number:
214-412-1510
Provider Enumeration Date:
09/27/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
972-279-1200

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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