Provider Demographics
NPI:1669759726
Name:PEDIATRIC DENTAL SERVICES
Entity type:Organization
Organization Name:PEDIATRIC DENTAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:JADID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-697-4173
Mailing Address - Street 1:2100 HEDGCOXE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3156
Mailing Address - Country:US
Mailing Address - Phone:972-517-8300
Mailing Address - Fax:972-517-8322
Practice Address - Street 1:2100 HEDGCOXE RD STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3156
Practice Address - Country:US
Practice Address - Phone:972-517-8300
Practice Address - Fax:972-517-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty