Provider Demographics
NPI:1932420221
Name:WILSHIRE FAMILY DENTAL AND ORTHODONTICS PLLC
Entity type:Organization
Organization Name:WILSHIRE FAMILY DENTAL AND ORTHODONTICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-914-0813
Mailing Address - Street 1:950 FM 156
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247
Mailing Address - Country:US
Mailing Address - Phone:940-648-8668
Mailing Address - Fax:940-648-8668
Practice Address - Street 1:950 FM 156
Practice Address - Street 2:SUITE 10
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247
Practice Address - Country:US
Practice Address - Phone:940-648-8668
Practice Address - Fax:940-648-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200621223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty