=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376941278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN MARY EDDINGTON, D.D.S., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2014
-----------------------------------------------------
Last Update Date | 12/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 US HWY 377 STE A
-----------------------------------------------------
City | ARGYLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76226-3958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-464-6664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2221 KINGS FOREST LN
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-3568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-280-7685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KATHLEEN MARY EDDINGTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 214-280-7685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 19740
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------