Provider Demographics
NPI:1013422047
Name:WHITE OAK FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:WHITE OAK FAMILY DENTAL PLLC
Other - Org Name:TODAY DENTAL OF DENTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-318-6329
Mailing Address - Street 1:520 E VINE ST UNIT 484
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-3821
Mailing Address - Country:US
Mailing Address - Phone:817-318-6329
Mailing Address - Fax:
Practice Address - Street 1:1800 BRINKER RD STE 290
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6179
Practice Address - Country:US
Practice Address - Phone:940-483-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28021OtherDR. CASTLE TX LICENSE
TX30802OtherDR. MAHONEY TX LICENSE
TX28081OtherDR. ANDERSON TX LICENSE