Provider Demographics
NPI:1831767383
Name:DEKOW DENTAL, PLLC
Entity type:Organization
Organization Name:DEKOW DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-537-4892
Mailing Address - Street 1:4460 FM 1626
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640
Mailing Address - Country:US
Mailing Address - Phone:512-537-4892
Mailing Address - Fax:
Practice Address - Street 1:4460 FM 1626 STE 200
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640
Practice Address - Country:US
Practice Address - Phone:512-537-4892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental