Provider Demographics
NPI:1740761550
Name:KB DENTAL PLANO P.A.
Entity Type:Organization
Organization Name:KB DENTAL PLANO P.A.
Other - Org Name:SOUTHFORK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BINDU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-544-4800
Mailing Address - Street 1:408 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3887
Mailing Address - Country:US
Mailing Address - Phone:972-544-4800
Mailing Address - Fax:972-739-9137
Practice Address - Street 1:7924 PRESTON RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2355
Practice Address - Country:US
Practice Address - Phone:972-544-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty