Organization
ASCENT DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN SMITH (CREDENTIALING MANAGER)
(502) 244-9859
Entity
Organization
Contact information
Practice address
1674 KELLER PKWY STE 180, KELLER, TX 76248-3756
(785) 764-4535
Mailing address
1674 KELLER PKWY STE 180, KELLER, TX 76248-3756
(785) 764-4535
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34027
STATE LICENSE
TX
Enumeration date
10/18/2019
Last updated
10/18/2019
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