Organization
IKIDS PEDIATRIC DENTISTRY AND ORTHODONTICS NFW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYSSA AGUILAR (DIRECTOR OF REVENUE & CREDENTIALING)
(817) 466-8554
Entity
Organization
Contact information
Practice address
7451 N BEACH ST, STE 140, FORT WORTH, TX 76137
(817) 466-8554
Mailing address
2500 E BROAD ST STE 204, MANSFIELD, TX 76063-4361
(817) 466-8554
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
27242
TX
Other
Enumeration date
06/05/2014
Last updated
03/04/2021
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