Provider Demographics
NPI:1326728932
Name:KDDS DENTAL PA
Entity Type:Organization
Organization Name:KDDS DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-557-7716
Mailing Address - Street 1:5228 VILLAGE CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4431
Mailing Address - Country:US
Mailing Address - Phone:972-519-0990
Mailing Address - Fax:
Practice Address - Street 1:4708 W PLANO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5335
Practice Address - Country:US
Practice Address - Phone:972-519-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental