Provider Demographics
NPI:1811423379
Name:KVILLAGE DENTAL
Entity Type:Organization
Organization Name:KVILLAGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:02201970
Authorized Official - Phone:972-242-0005
Mailing Address - Street 1:1028 MAC ARTHUR DR
Mailing Address - Street 2:#100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007
Mailing Address - Country:US
Mailing Address - Phone:972-242-0005
Mailing Address - Fax:972-242-0009
Practice Address - Street 1:1028 MAC ARTHUR DR
Practice Address - Street 2:#100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007
Practice Address - Country:US
Practice Address - Phone:972-242-0005
Practice Address - Fax:972-242-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty