Provider Demographics
NPI:1558932780
Name:IKIDS CHILDRENS DENTISTRY PLLC RANDOLPH WADE HAMILTON III SOLE MBR
Entity Type:Organization
Organization Name:IKIDS CHILDRENS DENTISTRY PLLC RANDOLPH WADE HAMILTON III SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONBOARDING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-244-4844
Mailing Address - Street 1:2970 BRANDYWINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5528
Mailing Address - Country:US
Mailing Address - Phone:770-692-1000
Mailing Address - Fax:
Practice Address - Street 1:7451 N BEACH ST STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-5160
Practice Address - Country:US
Practice Address - Phone:817-295-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty