Provider Demographics
NPI:1558014274
Name:KINGWOOD FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:KINGWOOD FAMILY AND COSMETIC DENTISTRY
Other - Org Name:STACY L NORMAN DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-359-9100
Mailing Address - Street 1:1542 GREEN OAK PLACE
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-359-9100
Mailing Address - Fax:281-359-0130
Practice Address - Street 1:1542 GREEN OAK PLACE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-9100
Practice Address - Fax:281-359-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty