Ikids Pediatric Dentistry Viridian, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

IKIDS PEDIATRIC DENTISTRY VIRIDIAN, PLLC

Practice address

4100 N. Collins St.
BLDG. 7, Ste. 100
Arlington, TX 76011

Phone

(682) 222-1010

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

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": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1992213987",
    "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": "4100 N. COLLINS ST.",
            "address_2": "BLDG. 7, STE. 100",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "76011",
            "telephone_number": "682-222-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKIDS PEDIATRIC DENTISTRY VIRIDIAN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "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": []
}

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