Provider Demographics
NPI:1366771149
Name:PARIS CHILDRENS DENTISTRY
Entity type:Organization
Organization Name:PARIS CHILDRENS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-919-5932
Mailing Address - Street 1:4550 LAMAR AVE
Mailing Address - Street 2:300
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5124
Mailing Address - Country:US
Mailing Address - Phone:903-905-4905
Mailing Address - Fax:
Practice Address - Street 1:4550 LAMAR AVE
Practice Address - Street 2:300
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5124
Practice Address - Country:US
Practice Address - Phone:903-905-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1554016-03Medicaid