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General NPI Number Information
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NPI Number | 1730453937
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Entity Type | Organization
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Legal Business Name | TEXAS PEDIATRIC DENTISTRY, PA
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 3109 S CUSTER RD SUITE 300
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City | MCKINNEY
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State | TX
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Zip | 75070-7170
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Country | US
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Telephone | 972-542-6662
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Fax | 972-542-6691
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Provider Business Mailing Address
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Address Line | 3109 S CUSTER RD SUITE 300
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City | MCKINNEY
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State | TX
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Zip | 75070-7170
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Country | US
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Telephone | 972-542-6662
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Fax | 972-542-6691
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. AMBER BROOKS
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Credential |
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Telephone | 972-542-6662
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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 | 20866
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License Number State | TX
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