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General NPI Number Information
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NPI Number | 1023300621
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Entity Type | Organization
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Legal Business Name | KRIS DENTAL PC
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Dates
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Enumeration Date | 05/15/2011
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 18480 KUYKENDAHL RD
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City | SPRING
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State | TX
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Zip | 77379-8123
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Country | US
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Telephone | 832-431-7286
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 NORFOLK ST
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City | HOUSTON
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State | TX
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Zip | 77098-4223
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Country | US
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Telephone | 832-431-7286
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SANJEEV KUMAR GOPALAKRISHNAN
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Credential | DDS
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Telephone | 832-431-7286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22113
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License Number State | TX
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