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General NPI Number Information
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NPI Number | 1972758605
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Entity Type | Organization
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Legal Business Name | SKY DENTAL, P.A.
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 18700 W LAKE HOUSTON PKWY STE A107
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City | ATASCOCITA
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State | TX
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Zip | 77346-3350
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Country | US
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Telephone | 281-964-1001
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Fax | 281-852-6770
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Provider Business Mailing Address
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Address Line | 18700 W LAKE HOUSTON PKWY STE A107
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City | ATASCOCITA
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State | TX
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Zip | 77346-3350
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Country | US
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Telephone | 281-964-1001
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Fax | 281-852-6770
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABIR HUSSAMY KANJ
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Credential | D.M.D.
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Telephone | 281-964-1001
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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 | 23107
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License Number State | TX
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