Provider Demographics
NPI:1245935030
Name:TRINITY PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:TRINITY PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:KYLIE
Authorized Official - Last Name:THORBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-964-7347
Mailing Address - Street 1:4000 BRYANT IRVIN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4153
Mailing Address - Country:US
Mailing Address - Phone:469-964-7347
Mailing Address - Fax:682-207-6391
Practice Address - Street 1:4000 BRYANT IRVIN RD STE 208
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4153
Practice Address - Country:US
Practice Address - Phone:830-822-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental