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General NPI Number Information
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NPI Number | 1215568274
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Entity Type | Organization
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Legal Business Name | KTJP HUNTSVILLE DENTAL PLLC
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 1333 WINDSOR ST
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City | HUNTSVILLE
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State | TX
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Zip | 77340-5615
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Country | US
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Telephone | 936-291-9021
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 WINDSOR ST
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City | HUNTSVILLE
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State | TX
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Zip | 77340-5615
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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 | OFFICE MANAGER
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Name | SUZANNE LE
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Credential |
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Telephone | 832-878-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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