Provider Demographics
NPI:1952016503
Name:WEST KERR DENTAL, PROFESSIONAL LIMITED LIABILITY C
Entity Type:Organization
Organization Name:WEST KERR DENTAL, PROFESSIONAL LIMITED LIABILITY C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNAH M
Authorized Official - Middle Name:C
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-671-1718
Mailing Address - Street 1:3164 JUNCTION HWY STE W-1
Mailing Address - Street 2:
Mailing Address - City:INGRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78025-3194
Mailing Address - Country:US
Mailing Address - Phone:830-367-1171
Mailing Address - Fax:
Practice Address - Street 1:3164 JUNCTION HWY STE W-1
Practice Address - Street 2:
Practice Address - City:INGRAM
Practice Address - State:TX
Practice Address - Zip Code:78025-3194
Practice Address - Country:US
Practice Address - Phone:830-367-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental