Provider Demographics
NPI:1710572334
Name:CUDDLE KIDS DENTAL CARE PLLC
Entity Type:Organization
Organization Name:CUDDLE KIDS DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISHELLE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-213-3282
Mailing Address - Street 1:5329 SYCAMORE SCHOOL ROAD
Mailing Address - Street 2:STE. 117
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5329 SYCAMORE SCHOOL ROAD
Practice Address - Street 2:STE. 117
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123
Practice Address - Country:US
Practice Address - Phone:713-213-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33605OtherTSBDE