NPI 1104243898 · live from the CMS NPI Registry
Abc123 Dental In Keller PLLC
Dentist, General Practice in Keller, TX. National Provider Identifier 1104243898, active.
NPI record
| NPI | 1104243898 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 460 Keller Pkwy Ste E, Keller, TX 76248 |
| Practice phone | 817-656-1215 |
| Enumerated | March 20, 2014 |
| Last updated | March 20, 2014 |
| Authorized official | Peter Vo, Owner |
| Other names | Abc123 Dental |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | 24637 (TX) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.