Provider Demographics
NPI:1922529874
Name:DENTIUM PEDIATRIC DENTAL P.C.
Entity Type:Organization
Organization Name:DENTIUM PEDIATRIC DENTAL P.C.
Other - Org Name:SHEER SMILES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLMAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-987-0787
Mailing Address - Street 1:2626 STONEBROOK PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1393
Mailing Address - Country:US
Mailing Address - Phone:972-987-0787
Mailing Address - Fax:
Practice Address - Street 1:2626 STONEBROOK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1393
Practice Address - Country:US
Practice Address - Phone:972-987-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1255696142OtherNPI TYPE 1