Organization
IKIDS PEDIATRIC DENTISTRY LAKEWOOD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYSSA N AGUILAR (DIRECTOR OF REVENUE & CREDENTIALING)
(817) 466-8554
Entity
Organization
Contact information
Practice address
2011 ABRAMS PARKWAY, DALLAS, TX 75214
(469) 581-9001
(469) 581-9002
Mailing address
2500 E BROAD ST STE 204, MANSFIELD, TX 76063-4361
(817) 466-8554
(682) 273-0663
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
06/30/2020
Last updated
03/04/2021
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