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General NPI Number Information
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NPI Number | 1487294799
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Entity Type | Organization
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Legal Business Name | WISH KIDS DENTISTRY
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 6805 NE LOOP 820 STE 402
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-6687
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Country | US
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Telephone | 817-383-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 5729 LEBANON RD STE 144268
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City | FRISCO
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State | TX
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Zip | 75034-7260
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Country | US
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Telephone | 817-383-0005
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TERRY DO
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Credential |
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Telephone | 817-383-0005
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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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