Provider Demographics
NPI:1871972893
Name:KMS DENTAL LLC
Entity type:Organization
Organization Name:KMS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-3993
Mailing Address - Street 1:4614 E. SHEA BLVD
Mailing Address - Street 2:SUITE D230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6027
Mailing Address - Country:US
Mailing Address - Phone:602-996-3993
Mailing Address - Fax:602-996-0675
Practice Address - Street 1:4614 E. SHEA BLVD
Practice Address - Street 2:SUITE D230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6027
Practice Address - Country:US
Practice Address - Phone:602-996-3993
Practice Address - Fax:602-996-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty