LAKE KIOWA FAMILY DENTAL PLLC NPI 1528423266

NPI Information

NPI: 1528423266
Provider Name: LAKE KIOWA FAMILY DENTAL, PLLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
100 KIOWA DR W
SUITE 200
LAKE KIOWA, TX
ZIP 76240
Phone: (940) 612-1555
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LAKE KIOWA FAMILY DENTAL, PLLC is a dental clinic center in Lake Kiowa, TX. LAKE KIOWA FAMILY DENTAL, PLLC NPI is 1528423266. The provider is registered as an organization entity type.

The provider's business location address is:

100 KIOWA DR W
SUITE 200
LAKE KIOWA, TX
ZIP 76240-584
Phone: (940) 612-1555

The provider's authorized official is Matthew A Bayne .
The authorized official title is Dentist and has the following contact phone number (940) 612-1555.

The enumeration date for this NPI number is 12/23/2015 and was last updated on 12/23/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	24498	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1518167915	OTHER	TEXAS	INDIVIDUAL NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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