Provider Demographics
NPI:1063829430
Name:O2 DENTAL PLLC
Entity Type:Organization
Organization Name:O2 DENTAL PLLC
Other - Org Name:O2 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:361-749-1992
Mailing Address - Street 1:9929 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5164
Mailing Address - Country:US
Mailing Address - Phone:361-749-1992
Mailing Address - Fax:
Practice Address - Street 1:9929 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 119
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5164
Practice Address - Country:US
Practice Address - Phone:361-749-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty