Provider Demographics
NPI:1568107167
Name:KID'S CHOICE DENTAL LLC
Entity Type:Organization
Organization Name:KID'S CHOICE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-317-4122
Mailing Address - Street 1:11126 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3608
Mailing Address - Country:US
Mailing Address - Phone:215-317-4122
Mailing Address - Fax:
Practice Address - Street 1:2137 WELSH RD # 1C1E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4963
Practice Address - Country:US
Practice Address - Phone:267-261-6842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty