Kidzania Dental, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

29173 Issued in TX

Legal business name

KIDZANIA DENTAL, LLC

Doing business as

Kidzania Pediatric Dentistry

Practice address

26785 E. University Dr, St. 102
Aubrey, TX 75068

Phone

(817) 483-2445

Fax

(817) 483-2677

NPI assigned

Jan 12, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Hussam Gharraph

Title

Owner

Phone

(817) 483-2445

Specialties & licenses 2

Addresses

Other names 1

• Kidzania Pediatric Dentistry Doing business as

Locations

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515715200000",
    "number": "1134637119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3851 SW GREEN OAKS BLVD, ST. 123",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "76017",
            "telephone_number": "817-483-2445",
            "fax_number": "817-483-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26785 E. UNIVERSITY DR, ST. 102",
            "city": "AUBREY",
            "state": "TX",
            "postal_code": "75068",
            "telephone_number": "817-483-2445",
            "fax_number": "817-483-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZANIA DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2018-01-12",
        "status": "A",
        "authorized_official_last_name": "GHARRAPH",
        "authorized_official_first_name": "HUSSAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-483-2445",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "29173",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "28910",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kidzania Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Dentistry in Aubrey, TX
• Providers in Aubrey, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2018; 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.