Provider Demographics
NPI:1467008904
Name:SKM DENTISTRY FRISCO PLLC
Entity Type:Organization
Organization Name:SKM DENTISTRY FRISCO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:KHALID
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-534-1915
Mailing Address - Street 1:4130 KATE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3918
Mailing Address - Country:US
Mailing Address - Phone:214-534-1915
Mailing Address - Fax:
Practice Address - Street 1:14725 LEBANON RD STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5531
Practice Address - Country:US
Practice Address - Phone:214-534-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31029OtherDDS