Provider Demographics
NPI:1467743450
Name:FRISCO KIDS DENTISTRY
Entity Type:Organization
Organization Name:FRISCO KIDS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-618-5200
Mailing Address - Street 1:6801 WARREN PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4174
Mailing Address - Country:US
Mailing Address - Phone:214-618-5200
Mailing Address - Fax:214-618-5201
Practice Address - Street 1:6801 WARREN PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4174
Practice Address - Country:US
Practice Address - Phone:214-618-5200
Practice Address - Fax:214-618-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184453201Medicaid