MEDICARE: KIM T. VAN, DMD II, P.A.

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	23133	TX

General Provider Information

NPI Number	:	1831501568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM T. VAN, DMD II, P.A.

Provider Business Mailing Address
First Line	:	2111 N COLLINS ST
Second Line	:	SUITE 203
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2848
Country	:	US
Telephone Number	:	817-459-2113
Fax Number	:	817-459-2123

Provider Business Practice Location Address
First Line	:	2111 N COLLINS ST
Second Line	:	SUITE 203
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2848
Country	:	US
Telephone Number	:	817-459-2113
Fax Number	:	817-459-2123

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIM T. VAN
Credential	:	DMD
Telephone Number	:	817-459-2113

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	05/29/2014

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