Organization
THE TEXAS CHILDREN'S DENTAL UNIVERSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELONIE RACHEL DUTTON D.D.S. (PEDIATRICS) (OWNER)
(409) 945-8080
Entity
Organization
Contact information
Practice address
1114 14TH ST N, TEXAS CITY, TX 77590-5413
(409) 945-8080
(409) 945-4325
Mailing address
1114 14TH ST N, TEXAS CITY, TX 77590-5413
(409) 945-8080
(409) 945-4325
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
17982
TX
1223P0221X
Pediatric Dentistry
Primary
17982
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149758802
—
TX
01
—
840977
UNITED CONCORDIA
TX
01
—
G60405-01
CHIPS
TX
Enumeration date
01/30/2008
Last updated
03/15/2010
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