MEDICARE: KAYCARE FAMILY DENTAL,PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1902626393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYCARE FAMILY DENTAL,PC

Provider Business Mailing Address
First Line	:	6559 OLD JACKSONVILLE HWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0720
Country	:	US
Telephone Number	:	903-747-3839
Fax Number	:	903-747-3842

Provider Business Practice Location Address
First Line	:	6559 OLD JACKSONVILLE HWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0720
Country	:	US
Telephone Number	:	903-747-3839
Fax Number	:	903-747-3842

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OLAKUNBI I ONIME
Credential	:	DDS
Telephone Number	:	903-283-6189

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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