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General NPI Number Information
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NPI Number | 1063736767
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Entity Type | Organization
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Legal Business Name | KIDS DENTAL TEXAS, PLLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 6047 BISSONNET ST
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City | HOUSTON
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State | TX
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Zip | 77081-6903
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Country | US
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Telephone | 713-432-7222
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Fax | 713-432-7221
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Provider Business Mailing Address
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Address Line | 6047 BISSONNET ST
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City | HOUSTON
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State | TX
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Zip | 77081-6903
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Country | US
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Telephone | 713-432-7222
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Fax | 713-432-7221
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CRAIG L VAN ALFEN
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Credential | DDS
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Telephone | 801-808-9465
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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 |
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License Number State |
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