MEDICARE: KBA ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25292	TX

General Provider Information

NPI Number	:	1053734939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KBA ASSOCIATES INC

Provider Business Mailing Address
First Line	:	4704 AIRLINE DR STE A1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3004
Country	:	US
Telephone Number	:	713-695-3400
Fax Number	:	713-695-3402

Provider Business Practice Location Address
First Line	:	4704 AIRLINE DR STE A1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3004
Country	:	US
Telephone Number	:	713-695-3400
Fax Number	:	713-695-3402

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BORIS J. MALESPIN
Credential	:	D.D.S.
Telephone Number	:	281-449-1053

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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