IKIDS PEDIATRIC DENTISTRY FORT WORTH, P.C. (NPI# 1710250097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710250097 |
| Entity Type | Organization |
| Organization Name | IKIDS PEDIATRIC DENTISTRY FORT WORTH, P.C. |
| Practice Address |
4504 W Vickery Blvd Fort Worth TX 76107 |
| Mailing Address |
2500 E Broad St Ste 104 Mansfield TX 76063-4181 |
| Practice Telephone | 8174532800 |
| Mailing Telephone | 8174668554 |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2018-08-15 |
| Authorized Official Name | ALYSSA AGUILAR (DIRECTOR OF REVENUE & CREDENTIALING) |
| Authorized Official Telephone | 8174668554 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
24272 | TX | Dental Providers |
| Street Address |
4504 W VICKERY BLVD |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306454178 | Susan Roberts Pediatric Dentistry Pllc | Dentist | 5411 Basswood Blvd Ste 201, Fort Worth, TX 76137-4479 | 2020-07-17 |
| 1538656988 | Dc Dental Associates of Fort Worth Pllc | Dentist | 1114 North Beach Street, Fort Worth, TX 76111 | 2018-04-20 |
| 1043754740 | Preece Church and Associates, Pediatric Dentistry | Dentist | 5700 Edwards Ranch Rd, Suite 100, Fort Worth, TX 76109-4127 | 2016-12-14 |
| 1619380805 | Ikids Pediatric Dentistry and Orthodontics Nfw | Dentist | 7451 N Beach St, Ste 140, Fort Worth, TX 76137 | 2014-06-05 |
| 1841601291 | Cook Childrens Physician Network | Dentist | 2600 E Berry Street, Fort Worth, TX 76105-4750 | 2014-05-19 |
| 1194022327 | Thien Tam Tran | Dentist | 225 Ne 28th St Ste 225, Fort Worth, TX 76164-7205 | 2011-02-24 |
| 1609001981 | Sheela Jayappa Patel | Dentist | 2600 East Berry Street, Fort Worth, TX 76105-4750 | 2009-05-15 |
| 1245405208 | Barnett Dental Group | Dentist | 6222 Hulen Bend Blvd, Fort Worth, TX 76132-2803 | 2008-04-29 |
| 1154463974 | Vajahat Yar Khan | Dentist | 225 Ne 28th St, Fort Worth, TX 76164-7205 | 2007-02-12 |
| 1790833143 | Isabel De Rosas Britain | Dentist | 1533 Merrimac Cir Ste 209, Fort Worth, TX 76107-6526 | 2007-01-08 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
Please comment or provide details below to improve the information on IKIDS PEDIATRIC DENTISTRY FORT WORTH, P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.