Provider Demographics
NPI:1679744924
Name:K. MIKE DOSSETT, D.D.S., INC.
Entity Type:Organization
Organization Name:K. MIKE DOSSETT, D.D.S., INC.
Other - Org Name:DOSSETT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:DOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-960-0082
Mailing Address - Street 1:618 W HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3162
Mailing Address - Country:US
Mailing Address - Phone:817-656-5566
Mailing Address - Fax:817-656-5569
Practice Address - Street 1:618 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3162
Practice Address - Country:US
Practice Address - Phone:817-656-5566
Practice Address - Fax:817-656-5569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K. MIKE DOSSETT, D.D.S., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty