Provider Demographics
NPI:1629344239
Name:JUST FOR KIDS DENTAL ENNIS
Entity Type:Organization
Organization Name:JUST FOR KIDS DENTAL ENNIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-351-9700
Mailing Address - Street 1:711 S CLAY ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5748
Mailing Address - Country:US
Mailing Address - Phone:972-351-9700
Mailing Address - Fax:888-222-9544
Practice Address - Street 1:711 S CLAY ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5748
Practice Address - Country:US
Practice Address - Phone:972-351-9700
Practice Address - Fax:888-222-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty