Provider Demographics
NPI:1104198076
Name:PEDIATRIC DENTAL CARE
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:POSNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-744-4551
Mailing Address - Street 1:2501 65TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-2218
Mailing Address - Country:US
Mailing Address - Phone:409-744-4551
Mailing Address - Fax:409-744-5702
Practice Address - Street 1:2501 65TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2218
Practice Address - Country:US
Practice Address - Phone:409-744-4551
Practice Address - Fax:409-744-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151231223P0221X
TX144331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041777601Medicaid
TXDENT 24368Medicaid