1235412743 NPI number — NADER KREIT DDS PLLC

Table of content: MRS. STEPHANIE RENEE ASMUS RD, LD (NPI 1174156517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235412743 NPI number — NADER KREIT DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NADER KREIT DDS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235412743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 SOUTHPOINT LOOP STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77351-8899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-327-9490
Provider Business Mailing Address Fax Number:
936-327-9496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 SOUTHPOINT LOOP
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77351-8899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-327-9490
Provider Business Practice Location Address Fax Number:
936-327-9496
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHN
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
936-327-9490

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  18352 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120788803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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