Healthcare Provider Details

I. General information

NPI: 1376941013
Provider Name (Legal Business Name): K&H DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 CHICO HIGHWAY
BRIDGEPORT TX
76426
US

IV. Provider business mailing address

1808 CHICO HIGHWAY
BRIDGEPORT TX
76426
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-3233
  • Fax:
Mailing address:
  • Phone: 940-683-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number26104
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26104
License Number StateTX

VIII. Authorized Official

Name: SUMEET SINGH MALHOTRA
Title or Position: OWNER
Credential:
Phone: 617-412-0792