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General NPI Number Information
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NPI Number | 1023195427
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Entity Type | Organization
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Legal Business Name | DENTISTRY 4 KIDZ, P.A.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | #1 EUREKA CIRCLE #103
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City | WICHITA FALLS
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State | TX
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Zip | 76308
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Country | US
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Telephone | 940-691-5027
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Fax | 940-691-5076
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Provider Business Mailing Address
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Address Line | #1 EUREKA CIRCLE #103
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City | WICHITA FALLS
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State | TX
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Zip | 76308
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Country | US
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Telephone | 940-691-5027
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Fax | 940-691-5076
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. PAUL STEVEN BONNER
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Credential | DDS
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Telephone | 940-691-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 14022
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License Number State | TX
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