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Organization
LAKE KIOWA SMILES, PLLC
Active
Organization
LAKE KIOWA SMILES, PLLC
Active
Other names
Lake Kiowa Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN TYLER HILL DDS (OWNER)
(940) 612-1555
Entity
Organization
Contact information
Practice address
100 KIOWA DR W, STE 200, LAKE KIOWA, TX 76240-9502
(940) 612-1555
(940) 612-1565
Mailing address
100 KIOWA DR W, STE 200, LAKE KIOWA, TX 76240-9502
(940) 612-1555
(940) 612-1565
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
25047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20547
STATE LICENSE
TX
Enumeration date
08/06/2018
Last updated
08/06/2018
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