MEDICARE: MIDLAND DENTISTRY 4 KIDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	24363	TX

General Provider Information

NPI Number	:	1952617482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLAND DENTISTRY 4 KIDS, PLLC

Provider Business Mailing Address
First Line	:	2817 W LOOP 250 N STE B
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-3205
Country	:	US
Telephone Number	:	432-694-4800
Fax Number	:	432-694-4811

Provider Business Practice Location Address
First Line	:	2817 W LOOP 250 N STE B
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-3205
Country	:	US
Telephone Number	:	432-699-2500
Fax Number	:	432-699-2501

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	TERESA ZWICKY
Credential	:
Telephone Number	:	480-866-8811

Provider Enumeration Date	:	08/21/2010
Last Update Date	:	01/29/2026

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