Provider Demographics
NPI:1346442944
Name:MCKASKLE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MCKASKLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:MCKASKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-599-8003
Mailing Address - Street 1:22167 WESTHEIMER PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8300
Mailing Address - Country:US
Mailing Address - Phone:281-599-8003
Mailing Address - Fax:281-599-7707
Practice Address - Street 1:22167 WESTHEIMER PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8300
Practice Address - Country:US
Practice Address - Phone:281-599-8003
Practice Address - Fax:281-599-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty