MEDICARE: KMA DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1750059911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMA DDS PLLC

Provider Business Mailing Address
First Line	:	13310 BEAMER RD STE F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6045
Country	:	US
Telephone Number	:	281-481-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	13310 BEAMER RD STE F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6045
Country	:	US
Telephone Number	:	281-481-9575
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	FAITH GASKINS
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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