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General NPI Number Information
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NPI Number | 1295397610
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Entity Type | Organization
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Legal Business Name | GRAPEVINE KIDS PLLC
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1230 S MAIN ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-5544
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Country | US
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Telephone | 972-258-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 S MAIN ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-5544
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Country | US
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Telephone | 817-909-2920
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. LYLE MATTHEW SCHOFIELD
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Credential | DDS
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Telephone | 469-900-5371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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