Provider Demographics
NPI:1093115438
Name:KITE DENTAL PLLC
Entity Type:Organization
Organization Name:KITE DENTAL PLLC
Other - Org Name:BRILLIANT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUNGCHUL
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-291-7023
Mailing Address - Street 1:701 N CENTRAL EXPY BLDG #4
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:469-291-7023
Mailing Address - Fax:469-291-7023
Practice Address - Street 1:701 N CENTRAL EXPY BLDG #4
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:469-291-7023
Practice Address - Fax:469-291-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty