Provider Demographics
NPI:1982057386
Name:KACHEPA GROUP DENTAL
Entity Type:Organization
Organization Name:KACHEPA GROUP DENTAL
Other - Org Name:INWOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GIVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHEPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-564-2307
Mailing Address - Street 1:12250 INWOOD RD#4
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12250 INWOOD RD STE 4
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8021
Practice Address - Country:US
Practice Address - Phone:817-564-2307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization