Organization
CHILDREN 1ST GRAND PRAIRIE, LLC
Active
Parent organization
DENTAL ASC, LLC
Other names
Children 1st Dental & Surgery Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL ASC, LLC
Authorized official
DEVIN LARSEN (CEO)
(208) 340-1840
Entity
Organization
Contact information
Practice address
3055 BARDIN RD # 400, GRAND PRAIRIE, TX 75052
(972) 279-1200
Mailing address
9709 LAKESIDE BLVD STE 350, SPRING, TX 77381-1213
(713) 489-2198
(713) 489-2978
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740561018
—
TX
Enumeration date
08/31/2011
Last updated
11/04/2024
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