Provider Demographics
NPI:1598097438
Name:TEXAS KIDS DENTAL CARE PA
Entity Type:Organization
Organization Name:TEXAS KIDS DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-858-6868
Mailing Address - Street 1:5301 N WOODMERE FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6457
Mailing Address - Country:US
Mailing Address - Phone:602-309-2180
Mailing Address - Fax:
Practice Address - Street 1:9411 ALAMEDA AVE
Practice Address - Street 2:STE P
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-5640
Practice Address - Country:US
Practice Address - Phone:915-858-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty