=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588372098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KREIT DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2022
-----------------------------------------------------
Last Update Date | 06/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 SOUTHPOINT LOOP STE 400
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77351-8899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-327-9490
-----------------------------------------------------
Fax | 936-327-9496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 SOUTHPOINT LOOP STE 400
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77351-8899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-327-9490
-----------------------------------------------------
Fax | 936-327-9496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NADER KREIT
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 936-327-9490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------