Healthcare Provider Details

I. General information

NPI: 1528620200
Provider Name (Legal Business Name): KE HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N PRESTON RD STE 20
PROSPER TX
75078-9291
US

IV. Provider business mailing address

3613 CURBSTONE WAY
PLANO TX
75074-8932
US

V. Phone/Fax

Practice location:
  • Phone: 972-426-8770
  • Fax:
Mailing address:
  • Phone: 281-770-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35140
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: