Provider Demographics
NPI:1538317623
Name:KIDZ & TEEN DENTAL
Entity Type:Organization
Organization Name:KIDZ & TEEN DENTAL
Other - Org Name:KIDZ & TEEN DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:MOHSIN
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-939-5439
Mailing Address - Street 1:4125 FAIRWAY DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6505
Mailing Address - Country:US
Mailing Address - Phone:972-939-5439
Mailing Address - Fax:972-939-7022
Practice Address - Street 1:4125 FAIRWAY DR.
Practice Address - Street 2:SUITE 135
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6505
Practice Address - Country:US
Practice Address - Phone:972-939-5439
Practice Address - Fax:972-939-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty