Provider Demographics
NPI:1194183251
Name:KMN DENTAL PC
Entity Type:Organization
Organization Name:KMN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-394-3440
Mailing Address - Street 1:23123 CINCO RANCH BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4042
Mailing Address - Country:US
Mailing Address - Phone:281-394-3440
Mailing Address - Fax:281-394-3933
Practice Address - Street 1:23123 CINCO RANCH BLVD
Practice Address - Street 2:STE 230
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4042
Practice Address - Country:US
Practice Address - Phone:281-394-3440
Practice Address - Fax:281-394-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00232251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty