Provider Demographics
NPI: | 1114302510 |
---|---|
Name: | QKT ENTERPRISES PLLC |
Entity Type: | Organization |
Organization Name: | QKT ENTERPRISES PLLC |
Other - Org Name: | STELLA DENTAL CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KELLY |
Authorized Official - Middle Name: | NGUYEN |
Authorized Official - Last Name: | VO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 832-488-9775 |
Mailing Address - Street 1: | 7160 BARKER CYPRESS RD |
Mailing Address - Street 2: | SUITE # E |
Mailing Address - City: | CYPRESS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77433-1380 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7160 BARKER CYPRESS RD |
Practice Address - Street 2: | SUITE # E |
Practice Address - City: | CYPRESS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77433-1380 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-488-9775 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-07-27 |
Last Update Date: | 2015-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 23675 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |