Provider Demographics
NPI:1144603838
Name:VALLEY RANCH FAMILY DENTISTRY
Entity Type:Organization
Organization Name:VALLEY RANCH FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAKINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMBATY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:888-888-8888
Mailing Address - Street 1:510 RANCH TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 RANCH TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4878
Practice Address - Country:US
Practice Address - Phone:888-888-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty