Provider Demographics
NPI:1881168458
Name:PKSK DENTAL PLLC
Entity type:Organization
Organization Name:PKSK DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:SARABJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-679-3630
Mailing Address - Street 1:12000 US HIGHWAY 380 STE 114
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12000 US HIGHWAY 380 STE 114
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2340
Practice Address - Country:US
Practice Address - Phone:214-414-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty