Provider Demographics
NPI:1710642855
Name:CHILDREN'S DENTISTRY OF ARLINGTON, PLLC
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF ARLINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:COYLE
Authorized Official - Last Name:CESTARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-794-7262
Mailing Address - Street 1:1000 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3149
Mailing Address - Country:US
Mailing Address - Phone:817-261-3100
Mailing Address - Fax:817-303-3715
Practice Address - Street 1:1000 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3149
Practice Address - Country:US
Practice Address - Phone:817-261-3100
Practice Address - Fax:817-303-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190129009Medicaid