Provider Demographics
NPI:1508287459
Name:SIMPLY KIDZ DENTAL, PLLC
Entity Type:Organization
Organization Name:SIMPLY KIDZ DENTAL, PLLC
Other - Org Name:SIMPLY KIDZ DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-705-2888
Mailing Address - Street 1:4865 HEDGCOXE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2406
Mailing Address - Country:US
Mailing Address - Phone:214-705-2888
Mailing Address - Fax:
Practice Address - Street 1:4865 HEDGCOXE RD
Practice Address - Street 2:STE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2406
Practice Address - Country:US
Practice Address - Phone:214-705-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty