Provider Demographics
NPI:1356615793
Name:NK DENTAL, P.A.
Entity type:Organization
Organization Name:NK DENTAL, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:KHUU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-465-0099
Mailing Address - Street 1:10139 HAMMERLY BLVD.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080
Mailing Address - Country:US
Mailing Address - Phone:713-465-0099
Mailing Address - Fax:713-465-0094
Practice Address - Street 1:10139 HAMMERLY BLVD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080
Practice Address - Country:US
Practice Address - Phone:713-465-0099
Practice Address - Fax:713-465-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 1223G0001X, 1223P0221X, 1223S0112X, 1223X0400X
TX225211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177961309Medicaid
TXB22521OtherTEXAS CHIP