=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750081931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K2 DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11620 HERO WAY WEST STE 140
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-697-5891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2405 FALLSHIRE CT
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-3983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-697-5891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | KUNTAL PATEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 972-697-5891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------