Provider Demographics
NPI:1124459607
Name:LITTLE ELM DENTAL CARE PA
Entity type:Organization
Organization Name:LITTLE ELM DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAIVAN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:AFKHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-577-9200
Mailing Address - Street 1:1801 PRECINCT LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3170
Mailing Address - Country:US
Mailing Address - Phone:817-577-9200
Mailing Address - Fax:817-281-9231
Practice Address - Street 1:800 W ELDORADO PKWY
Practice Address - Street 2:SUITE 124
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5088
Practice Address - Country:US
Practice Address - Phone:972-292-3820
Practice Address - Fax:972-292-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty