Provider Demographics
NPI:1902626393
Name:KAYCARE FAMILY DENTAL,PC
Entity type:Organization
Organization Name:KAYCARE FAMILY DENTAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAKUNBI
Authorized Official - Middle Name:I
Authorized Official - Last Name:ONIME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-283-6189
Mailing Address - Street 1:6559 OLD JACKSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0720
Mailing Address - Country:US
Mailing Address - Phone:903-747-3839
Mailing Address - Fax:903-747-3842
Practice Address - Street 1:6559 OLD JACKSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0720
Practice Address - Country:US
Practice Address - Phone:903-747-3839
Practice Address - Fax:903-747-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty