Provider Demographics
NPI:1962790626
Name:A TOOTH DOCTOR FOR KIDS DALLAS PLLC
Entity type:Organization
Organization Name:A TOOTH DOCTOR FOR KIDS DALLAS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-956-4411
Mailing Address - Street 1:4550 GUS THOMASSON RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1700
Mailing Address - Country:US
Mailing Address - Phone:512-371-1222
Mailing Address - Fax:614-462-2616
Practice Address - Street 1:3301 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7302
Practice Address - Country:US
Practice Address - Phone:602-956-4411
Practice Address - Fax:602-956-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty