Provider Demographics
NPI:1528768702
Name:KEY CITY KIDS DENTAL PLLC
Entity type:Organization
Organization Name:KEY CITY KIDS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-699-2044
Mailing Address - Street 1:6608 HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5082
Mailing Address - Country:US
Mailing Address - Phone:432-699-2044
Mailing Address - Fax:
Practice Address - Street 1:3781 CATCLAW DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8203
Practice Address - Country:US
Practice Address - Phone:432-699-3044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty