Provider Demographics
NPI:1871300285
Name:AFFORDABLE DENTIST OF KENEDY, PLLC
Entity type:Organization
Organization Name:AFFORDABLE DENTIST OF KENEDY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-241-3812
Mailing Address - Street 1:670 W CAMPBELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3361
Mailing Address - Country:US
Mailing Address - Phone:806-241-3812
Mailing Address - Fax:
Practice Address - Street 1:131 BUSINESS PARK BLVD STE 600
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-3512
Practice Address - Country:US
Practice Address - Phone:806-241-3812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty