Provider Demographics
NPI:1831906742
Name:CHILD HEALTHY DENTIST PLLC
Entity type:Organization
Organization Name:CHILD HEALTHY DENTIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-723-5052
Mailing Address - Street 1:3216 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1131
Mailing Address - Country:US
Mailing Address - Phone:832-723-5052
Mailing Address - Fax:
Practice Address - Street 1:3216 OAKMONT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1131
Practice Address - Country:US
Practice Address - Phone:832-723-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty