NPIMap

Organization Active NPI

Ikids Pediatric Dentistry, PC

  • Pediatric Dentistry
  • Mansfield, TX
National Provider Identifier
1043442387
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
24272 Issued in TX
Legal business name
IKIDS PEDIATRIC DENTISTRY, PC
Practice address
1756 Broad Park Cir N Ste 100
Mansfield, TX 76063
Phone
(817) 453-2800
Fax
(817) 453-2825
NPI assigned
Aug 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alyssa Aguilar
Title
Director of Revenue & Credentialing
Phone
(817) 466-8554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 24272 TX Primary

Addresses

Primary practice location

1756 Broad Park Cir N Ste 100
Mansfield, TX 76063

Mailing address

2500 E Broad St Ste 204
Mansfield, TX 76063-4361
Phone (817) 466-8554

National Provider Directory

National Provider Directory

Locations

1756 Broad Park Cir N
Ste 100
Mansfield, TX 76063
Phone (817) 453-2800

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1043442387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 E BROAD ST STE 204",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634361",
            "telephone_number": "817-466-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1756 BROAD PARK CIR N STE 100",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "817-453-2800",
            "fax_number": "817-453-2825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKIDS PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "AGUILAR",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE & CREDENTIALING",
        "authorized_official_telephone_number": "817-466-8554"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "24272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.