Provider Demographics
NPI:1104300789
Name:KDS SURGICAL ASSISTING, PLLC
Entity type:Organization
Organization Name:KDS SURGICAL ASSISTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:817-714-9066
Mailing Address - Street 1:7309 WINDING WAY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-2006
Mailing Address - Country:US
Mailing Address - Phone:817-714-9066
Mailing Address - Fax:
Practice Address - Street 1:7309 WINDING WAY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-2006
Practice Address - Country:US
Practice Address - Phone:817-714-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty