Provider Demographics
NPI:1922426154
Name:ABC FAMILY DENTAL KELLER LLC
Entity Type:Organization
Organization Name:ABC FAMILY DENTAL KELLER LLC
Other - Org Name:ABC FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-482-1555
Mailing Address - Street 1:460 KELLER PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2370
Mailing Address - Country:US
Mailing Address - Phone:817-482-1555
Mailing Address - Fax:877-230-8349
Practice Address - Street 1:460 KELLER PKWY STE E
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2370
Practice Address - Country:US
Practice Address - Phone:817-482-1555
Practice Address - Fax:877-230-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty