| Organization Name: | KIDZ CHOICE DENTAL PA |
| NPI Number: | 1003173634 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWIN KYLE DALTON (PRESIDENT) |
| Mailing Address: | 2415 Prince St Ste 105 Conway |
| State: | AR US |
| Postal Code: | 720343746 |
| Phone Number: | 5013272030 |
| Fax Number: | 5013270242 |
| NPI Enumeration Date: | 04/20/2012 |
| NPI Last Update Date: | 04/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2841 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |