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General NPI Number Information
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NPI Number | 1073043501
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Entity Type | Organization
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Legal Business Name | SKJ DENTAL, PLLC
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 3200 BELLMEAD DR
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City | BELLMEAD
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State | TX
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Zip | 76705-3077
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Country | US
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Telephone | 254-799-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 BELLMEAD DR
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City | BELLMEAD
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State | TX
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Zip | 76705-3077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MS. AMANDA SAIZ
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Credential |
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Telephone | 254-338-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | TX
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