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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 MAYFIELD DMD (PRESIDENT)
(770) 916-5028
Entity
Organization
Contact information
Practice address
1012 20TH STREET NORTH, TEXAS CITY, TX 77590
(770) 916-9000
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
(770) 916-5028
(678) 247-7858
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
04/19/2011
Last updated
12/19/2014
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