Provider Demographics
NPI:1548713688
Name:CARE FOR KIDS PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:CARE FOR KIDS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-608-7535
Mailing Address - Street 1:24510 EASTEX FWY STE 110
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2698
Mailing Address - Country:US
Mailing Address - Phone:281-608-7535
Mailing Address - Fax:
Practice Address - Street 1:24510 EASTEX FWY STE 110
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2698
Practice Address - Country:US
Practice Address - Phone:281-608-7535
Practice Address - Fax:281-608-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty