Provider Demographics
NPI:1891740023
Name:ROUNDY, KADE A (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KADE
Middle Name:A
Last Name:ROUNDY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 LA CANTERA PKWY
Mailing Address - Street 2:SUITE 20240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2422
Mailing Address - Country:US
Mailing Address - Phone:210-690-7668
Mailing Address - Fax:
Practice Address - Street 1:15900 LA CANTERA PKWY
Practice Address - Street 2:SUITE 20240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2422
Practice Address - Country:US
Practice Address - Phone:210-690-7668
Practice Address - Fax:210-690-7669
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98921223E0200X
TX264861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics