Provider Demographics
NPI:1487155826
Name:IKIDS PEDIATRIC DENTISTRY CASTLE HILLS, PLLC
Entity type:Organization
Organization Name:IKIDS PEDIATRIC DENTISTRY CASTLE HILLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-466-8554
Mailing Address - Street 1:2000 HIGHWAY 157 N STE 120
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4860
Mailing Address - Country:US
Mailing Address - Phone:817-466-8554
Mailing Address - Fax:
Practice Address - Street 1:1620 FM 544
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4591
Practice Address - Country:US
Practice Address - Phone:817-466-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty