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General NPI Number Information
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NPI Number | 1255616538
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Entity Type | Organization
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Legal Business Name | KINGWOOD DENTAL SPECIALISTS PC
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 1414 GREEN OAK TERRACE CT STE 400
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City | KINGWOOD
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State | TX
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Zip | 77339-2960
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Country | US
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Telephone | 281-359-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 GREEN OAK TERRACE CT STE 400
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City | KINGWOOD
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State | TX
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Zip | 77339-2960
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Country | US
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Telephone | 281-359-1011
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Fax |
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE MGR
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Name | BECKY KEEFER
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Credential |
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Telephone | 832-399-7450
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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 | 22853
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22814
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 19503
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22605
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11684
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 18851
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License Number State | TX
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