Healthcare Provider Details

I. General information

NPI: 1174220537
Provider Name (Legal Business Name): KS2 DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 BROADWAY ST STE O
GALVESTON TX
77551-1093
US

IV. Provider business mailing address

2221 DOVE HAVEN LN
LEAGUE CITY TX
77573-4182
US

V. Phone/Fax

Practice location:
  • Phone: 575-218-9337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: VANESSA ESPINOZA
Title or Position: MANAGER
Credential:
Phone: 281-832-1368