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General NPI Number Information
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NPI Number | 1508958117
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Entity Type | Organization
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Legal Business Name | KILLEEN FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 3300 E CENTRAL TEXAS EXPY SUITE #302
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City | KILLEEN
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State | TX
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Zip | 76543-5306
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Country | US
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Telephone | 254-699-6799
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Fax | 254-699-3465
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Provider Business Mailing Address
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Address Line | 3300 E CENTRAL TEXAS EXPY SUITE #302
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City | KILLEEN
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State | TX
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Zip | 76543-5306
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Country | US
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Telephone | 254-699-6799
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Fax | 254-699-3465
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MR. ANDRE YASSA
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Credential | DDS
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Telephone | 254-699-6799
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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 |
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License Number State |
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