Provider Demographics
NPI:1669927307
Name:DENTAL DEPOT OF HIGHLAND VILLAGE
Entity type:Organization
Organization Name:DENTAL DEPOT OF HIGHLAND VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HIMESH
Authorized Official - Middle Name:I
Authorized Official - Last Name:KANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-703-2525
Mailing Address - Street 1:PO BOX 561205
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056
Mailing Address - Country:US
Mailing Address - Phone:972-703-2525
Mailing Address - Fax:972-332-0141
Practice Address - Street 1:2460 FM 407
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3091
Practice Address - Country:US
Practice Address - Phone:972-966-1234
Practice Address - Fax:972-966-1233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL DEPOT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-23
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty