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General NPI Number Information
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NPI Number | 1316573009
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Entity Type | Organization
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Legal Business Name | AWESOME KIDS DENTISTRY PLLC
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 3502 CORINTH PKWY # 400
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City | CORINTH
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State | TX
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Zip | 76208-5481
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Country | US
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Telephone | 214-455-4487
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 GROVELAND CT
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City | DENTON
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State | TX
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Zip | 76210-0587
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Country | US
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Telephone | 214-455-4487
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. ALBERT YAMOAH
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Credential | DDS
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Telephone | 214-455-4487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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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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