MEDICARE: SK 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	29431	TX

General Provider Information

NPI Number	:	1942736988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SK DENTAL PLLC

Provider Business Mailing Address
First Line	:	5000 WESTERN CENTER BLVD STE 210
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2197
Country	:	US
Telephone Number	:	682-201-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 WESTERN CENTER BLVD STE 210
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2197
Country	:	US
Telephone Number	:	682-201-9757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHIV K KOHLI
Credential	:
Telephone Number	:	417-234-0915

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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