Healthcare Provider Details

I. General information

NPI: 1053531673
Provider Name (Legal Business Name): LOUIS KAVETSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N DICKINSON
RUSK TX
75785
US

IV. Provider business mailing address

100 FALCON HILL RD
PALESTINE TX
75803-9676
US

V. Phone/Fax

Practice location:
  • Phone: 903-683-3421
  • Fax: 903-683-7199
Mailing address:
  • Phone: 903-723-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13639
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: