Provider Demographics
NPI:1023195427
Name:DENTISTRY 4 KIDZ, P.A.
Entity Type:Organization
Organization Name:DENTISTRY 4 KIDZ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-691-5027
Mailing Address - Street 1:#1 EUREKA CIRCLE #103
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308
Mailing Address - Country:US
Mailing Address - Phone:940-691-5027
Mailing Address - Fax:940-691-5076
Practice Address - Street 1:#1 EUREKA CIRCLE #103
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308
Practice Address - Country:US
Practice Address - Phone:940-691-5027
Practice Address - Fax:940-691-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14022OtherSTATE DENTAL LISCENSE