Provider Demographics
NPI:1750859690
Name:KEMAH FAMILY DENTAL PC
Entity type:Organization
Organization Name:KEMAH FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROOPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-445-8588
Mailing Address - Street 1:27847 HUNTERS ROCK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4179
Mailing Address - Country:US
Mailing Address - Phone:479-445-8588
Mailing Address - Fax:
Practice Address - Street 1:401 FM 518 RD STE A
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-3281
Practice Address - Country:US
Practice Address - Phone:479-445-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN NUMBER