| The Texas Children's Dental Universe | |
|
1114 14th St N Texas City TX 77590-5413 | |
| (409) 945-8080 | |
| (409) 945-4325 |
| Full Name | The Texas Children's Dental Universe |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1114 14th St N, Texas City, Texas |
| Authorized Official Name and Position | Melonie Rachel Dutton (OWNER) |
| Authorized Official Contact | 4099458080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Texas Children's Dental Universe 1114 14th St N Texas City TX 77590-5413 Ph: (409) 945-8080 | The Texas Children's Dental Universe 1114 14th St N Texas City TX 77590-5413 Ph: (409) 945-8080 |
| NPI Number | 1285811364 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 03/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285811364 | NPI | - | NPPES |
| G60405-01 | Other | TX | CHIPS |
| 840977 | Other | TX | UNITED CONCORDIA |
| 149758802 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 17982 (Texas) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 17982 (Texas) | Primary |
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