Children 1St Grand Prairie, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CHILDREN 1ST GRAND PRAIRIE, LLC

Doing business as

Children 1st Dental & Surgery Center

Practice address

3055 Bardin Rd # 400
Grand Prairie, TX 75052

Phone

(972) 279-1200

NPI assigned

Aug 31, 2011

Organization subpart

Yes

Parent organization

DENTAL ASC, LLCAs reported in NPPES

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

Authorized official

Name

Devin Larsen

Title

Ceo

Phone

(208) 340-1840

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Children 1st Dental & Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Ambulatory surgical center certification: CCN 45C0451307

Legal name

CHILDREN 1ST DENTAL & SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Dec 6, 2023

Last certification

Jan 9, 2024

Ownership / control type

Proprietary

Facility address

3055 Bardin Road Ste 400
Grand Prairie, TX 75052

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Dental ASC LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Dental ASC, LLC

  • Ambulatory Surgical Clinic/Center
  • Mesquite, TX
  • NPI 1407137763
  NPPES parent name

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1740561018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 LAKESIDE BLVD STE 350",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773811213",
            "telephone_number": "713-489-2198",
            "fax_number": "713-489-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 BARDIN RD # 400",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "75052",
            "telephone_number": "972-279-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN 1ST GRAND PRAIRIE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL ASC, LLC",
        "enumeration_date": "2011-08-31",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740561018",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children 1st Dental & Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yi-Ju Chen, DDS
• Shawn Cherian, DO
• William Fredrick Cherry II, D.D.S.
• Chester Spencer,DDS,MSD,&Associates
• Timothy Chiang, PT, DPT
• Children First, Inc.
• Tenishia Chintankwa, NON EMERGENCY TRANSP
• Brian Nyasha Chitimira, DNP, APRN, PMHNP-BC
• Joshua Young Cho, DDS
• Christian Medical LLC

• Ambulatory Surgical Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.