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General NPI Number Information
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NPI Number | 1750859690
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Entity Type | Organization
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Legal Business Name | KEMAH FAMILY DENTAL PC
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 401 FM 518 RD STE A
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City | KEMAH
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State | TX
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Zip | 77565-3281
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Country | US
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Telephone | 479-445-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 27847 HUNTERS ROCK LN
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City | KATY
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State | TX
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Zip | 77494-4179
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Country | US
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Telephone | 479-445-8588
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROOPESH DASH
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Credential |
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Telephone | 479-445-8588
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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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