Provider Demographics
NPI:1659966323
Name:KDC STAPLES, PLLC
Entity Type:Organization
Organization Name:KDC STAPLES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-992-9500
Mailing Address - Street 1:6200 SARATOGA BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3477
Mailing Address - Country:US
Mailing Address - Phone:361-992-9500
Mailing Address - Fax:361-992-1862
Practice Address - Street 1:5525 S STAPLES ST STE B4
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5367
Practice Address - Country:US
Practice Address - Phone:361-992-9500
Practice Address - Fax:361-992-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty