Provider Demographics
NPI:1023895463
Name:KINGWOOD PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:KINGWOOD PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-535-1063
Mailing Address - Street 1:25719 CELTIC TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5113
Mailing Address - Country:US
Mailing Address - Phone:601-529-4278
Mailing Address - Fax:
Practice Address - Street 1:2815 W LAKE HOUSTON PKWY STE 105
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5220
Practice Address - Country:US
Practice Address - Phone:832-535-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty