PEDIATRIC DENTISTRY OF COLLEYVILLE P.A. NPI 1366708760

NPI Information

PEDIATRIC DENTISTRY OF COLLEYVILLE, P.A. is a dental clinic center in Colleyville, TX. PEDIATRIC DENTISTRY OF COLLEYVILLE, P.A. NPI is 1366708760. The provider is registered as an organization entity type.

The provider's business location address is:

4109 BROWN TRL
SUITE 102
COLLEYVILLE, TX
ZIP 76034-998
Phone: (817) 428-7704
Fax: (817) 428-8919

The provider's authorized official is Loria Guiatas Nahatis .
The authorized official title is Owner / Dentist and has the following contact phone number (817) 428-7704.

The enumeration date for this NPI number is 4/10/2012 and was last updated on 4/10/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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