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General NPI Number Information
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NPI Number | 1407189517
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Entity Type | Organization
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Legal Business Name | WINDOW TO THE BODY
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 850 W HWY 243
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City | KAUFMAN
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State | TX
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Zip | 75142
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Country | US
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Telephone | 888-336-8839
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Fax | 972-438-2540
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Provider Business Mailing Address
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Address Line | 850 W HWY 243
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City | KAUFMAN
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State | TX
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Zip | 75142
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Country | US
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Telephone | 888-336-8839
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Fax | 972-438-2540
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATT FREDERICK KERN
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Credential |
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Telephone | 888-336-8839
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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 |
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