Ikids Pediatric Dentistry Fort Worth, P.C.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

24272 Issued in TX

Legal business name

IKIDS PEDIATRIC DENTISTRY FORT WORTH, P.C.

Practice address

4504 W Vickery Blvd
Fort Worth, TX 76107

Phone

(817) 453-2800

NPI assigned

Feb 16, 2012

Organization subpart

No

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

Addresses

Locations

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1710250097",
    "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": "4504 W VICKERY BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76107",
            "telephone_number": "817-453-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKIDS PEDIATRIC DENTISTRY FORT WORTH, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "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": []
}

• Ika3 LLC (Lancaster Specialty Pharmacy)
• Misty Ikerd, PA-C
• Ikids Childrens Dentistry PLLC Randolph Wade Hamilton III Sole MBR
• Ikids Pediatric Care PLLC
• Ikids Pediatric Dentistry and Orthodontics NFW
• Asad Ikram, MD
• Vishnu Ilineni, MD
• Enrique Illingworth, LMSW
• Sabrina Illingworth, CPNP-AC
• Illume Diagnostic Imaging LLC

• Pediatric Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatric Dentistry in Texas

• 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.