Provider Demographics
NPI:1245587468
Name:S K DENTAL INC
Entity Type:Organization
Organization Name:S K DENTAL INC
Other - Org Name:1ST SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-416-2700
Mailing Address - Street 1:2810 E TRINITY MILLS RD
Mailing Address - Street 2:#179
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2545
Mailing Address - Country:US
Mailing Address - Phone:972-416-2700
Mailing Address - Fax:972-416-2722
Practice Address - Street 1:2810 E TRINITY MILLS RD
Practice Address - Street 2:#179
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2545
Practice Address - Country:US
Practice Address - Phone:972-416-2700
Practice Address - Fax:972-416-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty