Provider Demographics
NPI:1376888305
Name:TEXAS KIDS DENTAL CARE HORIZON
Entity Type:Organization
Organization Name:TEXAS KIDS DENTAL CARE HORIZON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-221-8166
Mailing Address - Street 1:13468 EASTLAKE BLVD.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6320
Mailing Address - Country:US
Mailing Address - Phone:915-852-5060
Mailing Address - Fax:915-852-3300
Practice Address - Street 1:13468 EASTLAKE BLVD.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-6320
Practice Address - Country:US
Practice Address - Phone:915-852-5060
Practice Address - Fax:915-852-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty