Provider Demographics
NPI:1669624656
Name:E. P. DENTISTRY 4 KIDS, PLLC
Entity type:Organization
Organization Name:E. P. DENTISTRY 4 KIDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:I
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-607-9999
Mailing Address - Street 1:9813 DYER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4795
Mailing Address - Country:US
Mailing Address - Phone:915-751-0123
Mailing Address - Fax:915-751-4200
Practice Address - Street 1:9813 DYER ST
Practice Address - Street 2:#100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4722
Practice Address - Country:US
Practice Address - Phone:915-751-0123
Practice Address - Fax:915-751-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty