Provider Demographics
NPI:1659560761
Name:ALLEN KIDS DENTISTRY PLLC
Entity Type:Organization
Organization Name:ALLEN KIDS DENTISTRY PLLC
Other - Org Name:JUPITER KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:ISAM
Authorized Official - Last Name:TAIYM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-396-8080
Mailing Address - Street 1:600 E BETHANY DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4050
Mailing Address - Country:US
Mailing Address - Phone:972-396-8080
Mailing Address - Fax:
Practice Address - Street 1:600 E BETHANY DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4050
Practice Address - Country:US
Practice Address - Phone:972-396-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty