Organization
FRISCO DENTISTRY FOR KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLI L ETTELBRICK D.D.S., M.S. (PARTNER)
(214) 387-0099
Entity
Organization
Contact information
Practice address
8380 WARREN PKWY, STE 400, FRISCO, TX 75034-4198
(214) 387-0099
Mailing address
8380 WARREN PKWY, STE 400, FRISCO, TX 75034-4198
(214) 387-0099
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578505038
NPI - INDIVIDUAL
—
01
—
1639364797
NPI - INDIVIDUAL
—
Enumeration date
08/09/2012
Last updated
08/09/2012
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