Provider Demographics
NPI:1578228268
Name:A&A DENTAL KIDS, PLLC
Entity Type:Organization
Organization Name:A&A DENTAL KIDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AIDE
Authorized Official - Middle Name:JACIVE
Authorized Official - Last Name:RUBIO-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-643-2500
Mailing Address - Street 1:3201 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-2320
Mailing Address - Country:US
Mailing Address - Phone:713-643-2500
Mailing Address - Fax:
Practice Address - Street 1:3201 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-2320
Practice Address - Country:US
Practice Address - Phone:713-643-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184849291Medicaid