Provider Demographics
NPI:1316573009
Name:AWESOME KIDS DENTISTRY PLLC
Entity Type:Organization
Organization Name:AWESOME KIDS DENTISTRY PLLC
Other - Org Name:LAKE CITIES PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-455-4487
Mailing Address - Street 1:2904 GROVELAND CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0587
Mailing Address - Country:US
Mailing Address - Phone:214-455-4487
Mailing Address - Fax:
Practice Address - Street 1:3502 CORINTH PKWY # 400
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5481
Practice Address - Country:US
Practice Address - Phone:214-455-4487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty