Provider Demographics
NPI:1114310828
Name:QUAIL VALLEY FAMILY DENTAL
Entity Type:Organization
Organization Name:QUAIL VALLEY FAMILY DENTAL
Other - Org Name:QUAIL VALLEY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KHALILAH
Authorized Official - Middle Name:NATHANISHA
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-499-8340
Mailing Address - Street 1:2260 FM 1092 RD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1802
Mailing Address - Country:US
Mailing Address - Phone:281-499-8340
Mailing Address - Fax:
Practice Address - Street 1:2260 FM 1092 RD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1802
Practice Address - Country:US
Practice Address - Phone:281-499-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUAIL VALLEY FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3391971Medicaid