Provider Demographics
NPI:1801293469
Name:CK DENTAL GROUP
Entity type:Organization
Organization Name:CK DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-402-7811
Mailing Address - Street 1:920 N VISTA RIDGE BLVD # 700
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7637
Mailing Address - Country:US
Mailing Address - Phone:512-402-7811
Mailing Address - Fax:
Practice Address - Street 1:920 N VISTA RIDGE BLVD # 700
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7637
Practice Address - Country:US
Practice Address - Phone:512-402-7811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty