Provider Demographics
NPI:1164685418
Name:KINGSLEY ROAD DENTAL CENTER PC
Entity Type:Organization
Organization Name:KINGSLEY ROAD DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-271-7111
Mailing Address - Street 1:1606 WEST KINGSLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-4218
Mailing Address - Country:US
Mailing Address - Phone:972-271-7111
Mailing Address - Fax:
Practice Address - Street 1:1606 WEST KINGSLEY ROAD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4218
Practice Address - Country:US
Practice Address - Phone:972-271-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty