MEDICARE: KINTSUGI DENTAL PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1841159357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINTSUGI DENTAL PLLC

Provider Business Mailing Address
First Line	:	3241 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-6052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3241 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-6052
Country	:	US
Telephone Number	:	469-358-5272
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	RASHMI THAPA
Credential	:
Telephone Number	:	469-358-5272

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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