Organization
IKIDS PEDIATRIC DENTISTRY FORT WORTH, P.C.
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
4504 W VICKERY BLVD, FORT WORTH, TX 76107
(817) 453-2800
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
24272
TX
Other
Enumeration date
02/16/2012
Last updated
03/04/2021
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