Provider Demographics
NPI:1235412743
Name:NADER KREIT DDS PLLC
Entity Type:Organization
Organization Name:NADER KREIT DDS PLLC
Other - Org Name:DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-327-9490
Mailing Address - Street 1:117 SOUTHPOINT LOOP STE 400
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8899
Mailing Address - Country:US
Mailing Address - Phone:936-327-9490
Mailing Address - Fax:936-327-9496
Practice Address - Street 1:117 SOUTHPOINT LOOP
Practice Address - Street 2:SUITE 400
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8899
Practice Address - Country:US
Practice Address - Phone:936-327-9490
Practice Address - Fax:936-327-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120788803Medicaid