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General NPI Number Information
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NPI Number | 1538793468
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Entity Type | Organization
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Legal Business Name | KC DENTAL GROUP PC
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Dates
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Enumeration Date | 02/29/2020
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Last Update Date | 02/29/2020
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Provider Practice Location Address
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Address Line | 1809 GOLDEN TRAIL CT STE 140
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City | CARROLLTON
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State | TX
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Zip | 75010-4667
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Country | US
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Telephone | 215-500-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 881 PARKER DR
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City | COPPELL
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State | TX
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Zip | 75019-3154
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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 | PRESIDENT
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Name | DR. JENN HWAN CHEN
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Credential | DMD
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Telephone | 215-500-3674
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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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