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General NPI Number Information
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NPI Number | 1902661168
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Entity Type | Organization
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Legal Business Name | LITTLE BOOTS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 3804 LENOX DR
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City | FORT WORTH
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State | TX
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Zip | 76107-1714
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Country | US
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Telephone | 314-630-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 3804 LENOX DR
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City | FORT WORTH
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State | TX
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Zip | 76107-1714
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Country | US
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Telephone | 314-630-3689
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Fax |
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Authorized Official
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Title or Position | OWNER / PEDIATRIC DENTIST
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Name | KATHRYN HOLTHAUS
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Credential | DDS
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Telephone | 314-630-3689
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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 |
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License Number State |
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