Healthcare Provider Details

I. General information

NPI: 1073043501
Provider Name (Legal Business Name): SKJ DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BELLMEAD DR
BELLMEAD TX
76705-3077
US

IV. Provider business mailing address

3200 BELLMEAD DR
BELLMEAD TX
76705-3077
US

V. Phone/Fax

Practice location:
  • Phone: 254-799-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. AMANDA SAIZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 254-338-1468