Provider Demographics
NPI:1407256647
Name:WORLD PEDIATRIC DENTAL
Entity Type:Organization
Organization Name:WORLD PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-888-0700
Mailing Address - Street 1:18707 HARDY OAK BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4791
Mailing Address - Country:US
Mailing Address - Phone:210-888-0700
Mailing Address - Fax:210-625-7398
Practice Address - Street 1:18707 HARDY OAK BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4791
Practice Address - Country:US
Practice Address - Phone:210-888-0700
Practice Address - Fax:210-625-7398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty