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Organization
KS2 TX, PC
Active
Organization
KS2 TX, PC
Active
Other names
Kool Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE G. MAYFIELD (PRESIDENT)
(770) 916-5028
Entity
Organization
Contact information
Practice address
4117 S STAPLES ST, CORPUS CHRISTI, TX 78411
(800) 920-9947
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
06/27/2011
Last updated
12/19/2014
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