| Laura K. Kincannon, Dds, Pllc | |
|
907 S Columbia Dr West Columbia TX 77486-3637 | |
| (979) 345-1451 | |
| Not Available |
| Full Name | Laura K. Kincannon, Dds, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 907 S Columbia Dr, West Columbia, Texas |
| Authorized Official Name and Position | Laura Katherine Kincannon (OWNER) |
| Authorized Official Contact | 9793451451 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laura K. Kincannon, Dds, Pllc 907 S Columbia Dr West Columbia TX 77486-3637 Ph: (979) 345-1451 | Laura K. Kincannon, Dds, Pllc 907 S Columbia Dr West Columbia TX 77486-3637 Ph: (979) 345-1451 |
| NPI Number | 1801265566 |
|---|---|
| Provider Enumeration Date | 09/23/2015 |
| Last Update Date | 09/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801265566 | NPI | - | NPPES |
| 1982969242 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 27950 (Texas) | Primary |
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