Provider Demographics
NPI:1780968362
Name:KZSS TEXAS CAPITAL DENTAL LTD, LLP
Entity type:Organization
Organization Name:KZSS TEXAS CAPITAL DENTAL LTD, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FAKERI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-569-0274
Mailing Address - Street 1:1015 E BRAKER LN STE 2-3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3449
Mailing Address - Country:US
Mailing Address - Phone:512-832-1121
Mailing Address - Fax:877-833-4825
Practice Address - Street 1:1015 E BRAKER LN STE 2-3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3449
Practice Address - Country:US
Practice Address - Phone:512-832-1121
Practice Address - Fax:877-833-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22714122300000X
TX21278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487871901Medicaid
TX1326114968Medicaid