Provider Demographics
NPI:1760728489
Name:KP DDS PLLC
Entity Type:Organization
Organization Name:KP DDS PLLC
Other - Org Name:MAGIC DENTAL TWO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:VU
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-659-5623
Mailing Address - Street 1:6052 N FRY RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1882
Mailing Address - Country:US
Mailing Address - Phone:832-659-5623
Mailing Address - Fax:
Practice Address - Street 1:6052 N FRY RD
Practice Address - Street 2:SUITE G
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1882
Practice Address - Country:US
Practice Address - Phone:832-659-5623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty