Provider Demographics
NPI:1972758605
Name:SKY DENTAL, P.A.
Entity Type:Organization
Organization Name:SKY DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAMY KANJ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-964-1001
Mailing Address - Street 1:18700 W LAKE HOUSTON PKWY STE A107
Mailing Address - Street 2:
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3350
Mailing Address - Country:US
Mailing Address - Phone:281-964-1001
Mailing Address - Fax:281-852-6770
Practice Address - Street 1:18700 W LAKE HOUSTON PKWY STE A107
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-3350
Practice Address - Country:US
Practice Address - Phone:281-964-1001
Practice Address - Fax:281-852-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty