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Organization
PEDIATRIC DENTISTRY OF COLLEYVILLE, P.A.
Active
Organization
PEDIATRIC DENTISTRY OF COLLEYVILLE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORIA GUIATAS NAHATIS D.D.S. (OWNER / DENTIST)
(817) 428-7704
Entity
Organization
Contact information
Practice address
4109 BROWN TRL, SUITE 102, COLLEYVILLE, TX 76034-3998
(817) 428-7704
(817) 428-8919
Mailing address
4109 BROWN TRL, SUITE 102, COLLEYVILLE, TX 76034-3998
(817) 428-7704
(817) 428-8919
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
21802
TX
261QD0000X
Dental Clinic/Center
—
TX
Other
Enumeration date
04/10/2012
Last updated
04/10/2012
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