Provider Demographics
NPI:1336682152
Name:K & Q DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:K & Q DENTAL GROUP, PLLC
Other - Org Name:DENTIST TREE OF FAIRFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORAMAPORNPILAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-507-3044
Mailing Address - Street 1:1737 MARAVILLA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28404 HWY 290
Practice Address - Street 2:SUITE G03
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:281-849-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty