Provider Demographics
NPI:1073398566
Name:TEXAS LITTLE TEETH PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:TEXAS LITTLE TEETH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIPRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-847-8525
Mailing Address - Street 1:12412 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2835
Mailing Address - Country:US
Mailing Address - Phone:832-899-4995
Mailing Address - Fax:
Practice Address - Street 1:12412 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2835
Practice Address - Country:US
Practice Address - Phone:832-899-4995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty