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General NPI Number Information
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NPI Number | 1649560590
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRIC DENTAL CENTER PLLC
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 751 HEBRON PKWY STE 330 ATTN. DR. KENDRA BEHRAM
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City | LEWISVILLE
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State | TX
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Zip | 75057-5054
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Country | US
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Telephone | 240-645-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 860 HEBRON PKWY STE 201 ATTN. DR. KENDRA BEHRAM
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City | LEWISVILLE
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State | TX
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Zip | 75057-5143
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Country | US
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Telephone | 240-645-5940
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. KENDRA UGO BEHRAM
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Credential | DDS
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Telephone | 240-645-5940
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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 | 026115
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License Number State | TX
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