Provider Demographics
NPI:1992281604
Name:KSM DENTAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:KSM DENTAL ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRINIA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-482-6300
Mailing Address - Street 1:1617 E MCCART ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-5645
Mailing Address - Country:US
Mailing Address - Phone:940-482-6300
Mailing Address - Fax:940-482-6270
Practice Address - Street 1:1617 E MCCART ST STE 100
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-5645
Practice Address - Country:US
Practice Address - Phone:940-482-6300
Practice Address - Fax:940-482-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23960261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental