Kids Dental Center PLLC
Organization Active NPI Dentist · Atlanta, TX
NPI 1508233115 · NPPES record last updated Aug 31, 2015
Key facts
- NPI
- 1508233115
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 26442 (TX)
- Legal business name
- KIDS DENTAL CENTER PLLC
- Practice address
- 908 W Main St
Atlanta, TX 75551-3430 - Phone
- (903) 831-1000
- NPI assigned
- Aug 31, 2015
- Organization subpart
- No
Authorized official
- Name
- David M Glass, DDS
- Title
- Owner/Dentist
- Phone
- (903) 831-1000
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 26442 | TX | Yes |
Addresses
Primary practice location
908 W Main St
Atlanta, TX 75551-3430
Mailing address
908 W Main St
Atlanta, TX 75551-3430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 282579601 | Medicaid | TX |
Other providers in Atlanta, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.