Provider Demographics
NPI:1235519406
Name:KNOX VILLAGE DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:KNOX VILLAGE DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALVAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-265-7771
Mailing Address - Street 1:2325 N FITZHUGH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3058
Mailing Address - Country:US
Mailing Address - Phone:214-265-7771
Mailing Address - Fax:214-559-7078
Practice Address - Street 1:2325 N FITZHUGH AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3058
Practice Address - Country:US
Practice Address - Phone:214-265-7771
Practice Address - Fax:214-559-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty