Provider Demographics
NPI:1649560590
Name:ABC PEDIATRIC DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:ABC PEDIATRIC DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA UGO
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-645-5940
Mailing Address - Street 1:860 HEBRON PKWY STE 201
Mailing Address - Street 2:ATTN. DR. KENDRA BEHRAM
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5143
Mailing Address - Country:US
Mailing Address - Phone:240-645-5940
Mailing Address - Fax:
Practice Address - Street 1:751 HEBRON PKWY STE 330
Practice Address - Street 2:ATTN. DR. KENDRA BEHRAM
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5054
Practice Address - Country:US
Practice Address - Phone:240-645-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0261151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty