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General NPI Number Information
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NPI Number | 1659560761
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Entity Type | Organization
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Legal Business Name | ALLEN KIDS DENTISTRY PLLC
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 600 E BETHANY DR SUITE 130
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City | ALLEN
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State | TX
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Zip | 75002-4050
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Country | US
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Telephone | 972-396-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E BETHANY DR SUITE 130
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City | ALLEN
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State | TX
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Zip | 75002-4050
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Country | US
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Telephone | 972-396-8080
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SALEH ISAM TAIYM
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Credential | D.D.S.
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Telephone | 972-396-8080
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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 | 21706
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License Number State | TX
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