| Pediatric Dentistry Of Colleyville, P.a. | |
|
4109 Brown Trl Suite 102 Colleyville TX 76034-3998 | |
| (817) 428-7704 | |
| (817) 428-8919 |
| Full Name | Pediatric Dentistry Of Colleyville, P.a. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4109 Brown Trl, Colleyville, Texas |
| Authorized Official Name and Position | Loria Guiatas Nahatis (OWNER / DENTIST) |
| Authorized Official Contact | 8174287704 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Of Colleyville, P.a. 4109 Brown Trl Suite 102 Colleyville TX 76034-3998 Ph: (817) 428-7704 | Pediatric Dentistry Of Colleyville, P.a. 4109 Brown Trl Suite 102 Colleyville TX 76034-3998 Ph: (817) 428-7704 |
| NPI Number | 1366708760 |
|---|---|
| Provider Enumeration Date | 04/10/2012 |
| Last Update Date | 04/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366708760 | NPI | - | NPPES |
| 1629026430 | Other | TX | INDIVIDUAL NPI |
| 18278 | Other | TX | DENTAL LICENSE |
| 1619010972 | Other | TX | INDIVIDUAL NPI |
| 21802 | Other | TX | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 21802 (Texas) | Primary |
| 261QD0000X | Clinic/center - Dental | (Texas) | Secondary |
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