Organization
CHILD STUDY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORY R RHOADES (CHIEF FINANCIAL OFFICER)
(682) 885-4480
Entity
Organization
Contact information
Practice address
1300 W LANCASTER AVE, FORT WORTH, TX 76102-3410
(817) 390-2904
(817) 390-2901
Mailing address
1300 W LANCASTER AVE, FORT WORTH, TX 76102-3410
(817) 390-2904
(817) 390-2901
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22961
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091294102
—
TX
05
—
189125101
—
TX
Enumeration date
02/27/2008
Last updated
12/12/2022
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