Organization
KIDS PEDIATRIC DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISABETH ROWOLD-GARCIAMENDEZ D.D.S., M.S. (OWNER)
(972) 727-0011
Entity
Organization
Contact information
Practice address
335 N ALLEN DR, ALLEN, TX 75013-2539
(972) 727-0011
(972) 727-0707
Mailing address
335 N ALLEN DR, ALLEN, TX 75013-2539
(972) 727-0011
(972) 727-0707
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
18425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000ZBX696
BCBS OF MA
MA
05
—
0912743-02
—
TX
01
—
85D713
BCBS OF TX
TX
01
—
861423
UNITED CONCORDIA
TX
01
—
900-53478
BCBS OF ALABAMA
AL
Enumeration date
08/11/2010
Last updated
08/11/2010
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