Provider Demographics
NPI:1932420221
Name:WILSHIRE FAMILY DENTAL AND ORTHODONTICS
Entity Type:Organization
Organization Name:WILSHIRE FAMILY DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-447-3535
Mailing Address - Street 1:225 S E JOHN JONES DRIVE
Mailing Address - Street 2:#103
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8327
Mailing Address - Country:US
Mailing Address - Phone:817-447-3535
Mailing Address - Fax:
Practice Address - Street 1:225 SE JOHN JONES DR
Practice Address - Street 2:#103
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8341
Practice Address - Country:US
Practice Address - Phone:817-447-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200621223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty