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General NPI Number Information
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NPI Number | 1790171221
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Entity Type | Organization
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Legal Business Name | GK DENTAL P.A.
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 404 W. POWELL LANE; STE 102
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City | AUSTIN
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State | TX
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Zip | 78753
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Country | US
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Telephone | 248-528-2116
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Fax | 502-996-8282
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Provider Business Mailing Address
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Address Line | 404 W. POWELL LANE; STE 102
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City | AUSTIN
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State | TX
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Zip | 78753
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Country | US
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Telephone | 512-301-1505
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Fax | 888-503-5605
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE
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Name | JOY L STEVENS
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Credential |
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Telephone | 502-244-2441
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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 | 25128
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License Number State | TX
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