Provider Demographics
NPI:1821425430
Name:CHILDREN 1ST HOUSTON WEST, LLC
Entity Type:Organization
Organization Name:CHILDREN 1ST HOUSTON WEST, LLC
Other - Org Name:CHILDREN 1ST DENTAL & SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:O
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-279-1200
Mailing Address - Street 1:3055 BARDIN RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3819
Mailing Address - Country:US
Mailing Address - Phone:214-412-1500
Mailing Address - Fax:214-412-1510
Practice Address - Street 1:8700 S GESSNER DR. SUITE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:214-412-1500
Practice Address - Fax:214-412-1510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL ASC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-27
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical