| Lake Kiowa Family Dental, Pllc | |
|
100 Kiowa Dr W Suite 200 Lake Kiowa TX 76240-9584 | |
| (940) 612-1555 | |
| Not Available |
| Full Name | Lake Kiowa Family Dental, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 100 Kiowa Dr W, Lake Kiowa, Texas |
| Authorized Official Name and Position | Matthew A Bayne (DENTIST) |
| Authorized Official Contact | 9406121555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Kiowa Family Dental, Pllc 100 Kiowa Dr W Suite 200 Lake Kiowa TX 76240-9584 Ph: (940) 612-1555 | Lake Kiowa Family Dental, Pllc 100 Kiowa Dr W Suite 200 Lake Kiowa TX 76240-9584 Ph: (940) 612-1555 |
| NPI Number | 1528423266 |
|---|---|
| Provider Enumeration Date | 12/23/2015 |
| Last Update Date | 12/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528423266 | NPI | - | NPPES |
| 1518167915 | Other | TX | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 24498 (Texas) | Primary |
Lake Kiowa Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Kiowa Dr W, Ste 200, Lake Kiowa, TX 76240 Phone: 940-612-1555 Fax: 940-612-1565 |