Provider Demographics
NPI:1033757885
Name:KILLEEN AND HEIGHTS DENTAL CENTERS, PLLC
Entity Type:Organization
Organization Name:KILLEEN AND HEIGHTS DENTAL CENTERS, PLLC
Other - Org Name:KILLEEN DENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1405 E ELMS RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2810
Mailing Address - Country:US
Mailing Address - Phone:254-519-4700
Mailing Address - Fax:
Practice Address - Street 1:1405 E ELMS RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2810
Practice Address - Country:US
Practice Address - Phone:254-519-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KILLEEN AND HEIGHTS DENTAL CENTERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty