Ikids Pediatric Dentistry Ennis, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

IKIDS PEDIATRIC DENTISTRY ENNIS, PLLC

Practice address

711 S Clay St Ste a
Ennis, TX 75119

Phone

(682) 222-1010

NPI assigned

Mar 29, 2018

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 2

Addresses

Locations

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

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1952806085",
    "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": "711 S CLAY ST STE A",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "75119",
            "telephone_number": "682-222-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKIDS PEDIATRIC DENTISTRY ENNIS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-29",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Michele Hopkins
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• Stephanie Lee Humann, COTA
• Onely Elizabeth Hunter, LMT
• Brooke Lowe Igun, DDS
• Raluchukwu Iloanugo, PT, DPT
• Impact Health Direct Primary Care, PLLC
• Independent Order of Odd Fellows Grand Lodge 100F of Texas
• Innate Medical Solutions PLLC
• International Healthcare Supplies & Equipment Inc

• Pediatric Dentistry in Ennis, TX
• Providers in Ennis, 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.