Provider Demographics
NPI:1013655141
Name:KC VENTURES DENTAL PLLC
Entity Type:Organization
Organization Name:KC VENTURES DENTAL PLLC
Other - Org Name:KAM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMDI
Authorized Official - Middle Name:
Authorized Official - Last Name:IRONDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-421-5950
Mailing Address - Street 1:6920 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6920 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9646
Practice Address - Country:US
Practice Address - Phone:281-421-5950
Practice Address - Fax:281-421-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33565OtherTEXAS STATE BOARD OF DENTAL EXAMINERS