Provider Demographics
NPI:1649855792
Name:KIDZANIA FORNEY PLLC
Entity type:Organization
Organization Name:KIDZANIA FORNEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARRAPH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-709-8822
Mailing Address - Street 1:3851 SW GREEN OAKS BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4130
Mailing Address - Country:US
Mailing Address - Phone:817-483-2445
Mailing Address - Fax:817-483-2677
Practice Address - Street 1:132 KROGER DR # 300
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-2853
Practice Address - Country:US
Practice Address - Phone:817-483-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty