Healthcare Provider Details

I. General information

NPI: 1992281604
Provider Name (Legal Business Name): KSM DENTAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 E MCCART ST STE 100
KRUM TX
76249-5645
US

IV. Provider business mailing address

1617 E MCCART ST STE 100
KRUM TX
76249-5645
US

V. Phone/Fax

Practice location:
  • Phone: 940-482-6300
  • Fax: 940-482-6270
Mailing address:
  • Phone: 940-482-6300
  • Fax: 940-482-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number23960
License Number StateTX

VIII. Authorized Official

Name: KATRINIA SUE MCBRIDE
Title or Position: DENTIST
Credential: DDS
Phone: 940-482-6300