Provider Demographics
NPI:1740605138
Name:KENGSKOOL, SIRETHON RITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIRETHON
Middle Name:RITA
Last Name:KENGSKOOL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 COIT RD
Mailing Address - Street 2:#140
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1371
Mailing Address - Country:US
Mailing Address - Phone:469-209-9077
Mailing Address - Fax:
Practice Address - Street 1:8949 COIT RD
Practice Address - Street 2:#140
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-1371
Practice Address - Country:US
Practice Address - Phone:469-209-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-22
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist