| Lake Kiowa Family Dental | |
|
100 Kiowa Dr W, Ste 200 Lake Kiowa TX 76240-9502 | |
| (940) 612-1555 | |
| (940) 612-1565 |
| Full Name | Lake Kiowa Family Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 100 Kiowa Dr W, Ste 200, Lake Kiowa, Texas |
| Authorized Official Name and Position | Benjamin Tyler Hill (OWNER) |
| Authorized Official Contact | 9406121555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Kiowa Family Dental 100 Kiowa Dr W, Ste 200 Lake Kiowa TX 76240-9502 Ph: (940) 612-1555 | Lake Kiowa Family Dental 100 Kiowa Dr W, Ste 200 Lake Kiowa TX 76240-9502 Ph: (940) 612-1555 |
| NPI Number | 1952889404 |
|---|---|
| Provider Enumeration Date | 08/06/2018 |
| Last Update Date | 08/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952889404 | NPI | - | NPPES |
| 20547 | Other | TX | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 25047 (Texas) | Primary |
Lake Kiowa Family Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Kiowa Dr W, Suite 200, Lake Kiowa, TX 76240 Phone: 940-612-1555 |