Healthcare Provider Details

I. General information

NPI: 1104300789
Provider Name (Legal Business Name): KDS SURGICAL ASSISTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 WINDING WAY DR
ARLINGTON TX
76001-2006
US

IV. Provider business mailing address

7309 WINDING WAY DR
ARLINGTON TX
76001-2006
US

V. Phone/Fax

Practice location:
  • Phone: 817-714-9066
  • Fax:
Mailing address:
  • Phone: 817-714-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. KELLY DEAN SANDERS
Title or Position: SURGICAL FIRST ASSISTANT
Credential: LSA
Phone: 817-714-9066