| Children's Dental Clinic | |
|
2700 S 1st St Austin TX 78704-5421 | |
| (512) 442-4338 | |
| (512) 442-6074 |
| Full Name | Children's Dental Clinic |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2700 S 1st St, Austin, Texas |
| Authorized Official Name and Position | James Kirk Simons (OWNER) |
| Authorized Official Contact | 5124424338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Dental Clinic 2700 S 1st St Austin TX 78704-5421 Ph: (512) 442-4338 | Children's Dental Clinic 2700 S 1st St Austin TX 78704-5421 Ph: (512) 442-4338 |
| NPI Number | 1376619502 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 04/01/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376619502 | NPI | - | NPPES |
| 151451501 | Medicaid | TX | |
| G60054 | Other | TX | CHIP GROUP IDENTIFIER |
| 0013142 | Other | TX | FORTIS FACILITY IDENTIFIE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9122 (Texas) | Primary |
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