Provider Demographics
NPI:1073043501
Name:SKJ DENTAL, PLLC
Entity Type:Organization
Organization Name:SKJ DENTAL, PLLC
Other - Org Name:BELLMEAD KID'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-338-1468
Mailing Address - Street 1:3200 BELLMEAD DR
Mailing Address - Street 2:
Mailing Address - City:BELLMEAD
Mailing Address - State:TX
Mailing Address - Zip Code:76705-3077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 BELLMEAD DR
Practice Address - Street 2:
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705-3077
Practice Address - Country:US
Practice Address - Phone:254-799-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372888302Medicaid
TX372888301Medicaid