| Pediatric Dentristry Of Mansfield,pllc | |
|
1830 E Broad St Ste104 Mansfield TX 76063-9162 | |
| (817) 473-7171 | |
| (817) 473-2594 |
| Full Name | Pediatric Dentristry Of Mansfield,pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1830 E Broad St, Mansfield, Texas |
| Authorized Official Name and Position | Deborah C. Sullivan (OWNER) |
| Authorized Official Contact | 8174737171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentristry Of Mansfield,pllc 1830 E Broad St Ste 104 Mansfield TX 76063-9161 Ph: (817) 473-7171 | Pediatric Dentristry Of Mansfield,pllc 1830 E Broad St Ste104 Mansfield TX 76063-9162 Ph: (817) 473-7171 |
| NPI Number | 1508133224 |
|---|---|
| Provider Enumeration Date | 11/23/2011 |
| Last Update Date | 12/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508133224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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