Provider Demographics
NPI:1932881323
Name:LITTLE DENTAL PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:LITTLE DENTAL PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIYM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-677-9165
Mailing Address - Street 1:17119 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2232
Mailing Address - Country:US
Mailing Address - Phone:210-494-4699
Mailing Address - Fax:210-495-0558
Practice Address - Street 1:17119 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2232
Practice Address - Country:US
Practice Address - Phone:210-494-4699
Practice Address - Fax:210-495-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty