1952616179 NPI number — CHILDREN'S DENTAL CENTRE OF IRVING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952616179 NPI number — CHILDREN'S DENTAL CENTRE OF IRVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S DENTAL CENTRE OF IRVING
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:
1952616179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8870 N MACARTHUR BLVD
Provider Second Line Business Mailing Address:
A101
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-7833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-484-3199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8870 N MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
A101
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75063-7833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-484-3199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KUBA
Authorized Official First Name:
REENA
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
214-293-2186

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  21765 , 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)

  • Identifier: 1164516902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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