Ikids Pediatric Dentistry Burleson, PLLC
Dentist, Pediatric Dentistry in Burleson, TX. Organization (NPI-2).
NPI number1063755437
StatusActive
Last updated in NPPESMar 4, 2021
Details
- NPI
- 1063755437
- Entity type
- Organization (NPI-2)
- Legal business name
- Ikids Pediatric Dentistry Burleson, PLLC
- Organization subpart
- No
- Enumeration date
- Apr 3, 2013
- Certification date
- Mar 4, 2021
- Last updated
- Mar 4, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | 24272 | TX | Yes |
Practice location
1009 Sw Alsbury BlvdBurleson, TX 76028
Phone 817-295-1144 · Fax 817-295-2244
Mailing address
2500 E Broad St Ste 204Mansfield, TX 76063-4361
Phone 817-466-8554
Authorized official
Alyssa Aguilar
Director Of Revenue & Credentialing
8174668554
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