Provider Demographics
NPI:1538259452
Name:FAMILY & COSMETIC DENTISTY
Entity type:Organization
Organization Name:FAMILY & COSMETIC DENTISTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-567-4881
Mailing Address - Street 1:240 E HIGHWAY 243
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2315
Mailing Address - Country:US
Mailing Address - Phone:903-567-4881
Mailing Address - Fax:903-567-5149
Practice Address - Street 1:240 E HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2315
Practice Address - Country:US
Practice Address - Phone:903-567-4881
Practice Address - Fax:903-567-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty