Ko Dental Group, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

KO DENTAL GROUP, PC

Practice address

302 S. Avenue Q
Clifton, TX 76634

Phone

(254) 675-3518

Fax

(254) 675-1262

NPI assigned

Oct 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lynda Marliessa Clark

Title

Am

Phone

(254) 784-0508

Specialties & licenses 1

Addresses

Other names 1

• Dynamic Family Dentistry Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Kennedy, DMD

  • General Practice Dentistry
  • Clifton, TX
  • NPI 1780123356
  NPD
• Casi Lyn Carlson, D.M.D.

  • Dentist
  • Hamilton, TX
  • NPI 1023446473
  NPD (past)
• Dee Anna Walker, DDS

  • Dentist
  • Clifton, TX
  • NPI 1043214059
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053911396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 S. AVENUE Q",
            "city": "CLIFTON",
            "state": "TX",
            "postal_code": "76634",
            "telephone_number": "254-675-3518",
            "fax_number": "254-675-1262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 S. AVENUE Q",
            "city": "CLIFTON",
            "state": "TX",
            "postal_code": "76634",
            "telephone_number": "254-675-3518",
            "fax_number": "254-675-1262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 N Rice St",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "TX",
            "postal_code": "765311857",
            "country_code": "US",
            "telephone_number": "254-386-8957",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 E Main St",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "TX",
            "postal_code": "765311922",
            "country_code": "US",
            "telephone_number": "254-386-8957",
            "fax_number": "254-386-3240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KO DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "MARLIESSA",
        "authorized_official_title_or_position": "AM",
        "authorized_official_telephone_number": "254-784-0508"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dynamic Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dynamic Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Raygenna Heath
• Waylon Henderson, PTA
• Jennifer E Hudson, FNP-C
• Meredith Addison Humphreys
• Scott Kennedy, DMD
• Amanda Marie Lella, RN
• Lily Lingo Therapy, PLLC
• Cathleen Lochte, MS
• Kenneth W Lowrance, MS, RN, CS, FNP-C
• Lutheran Sunset Ministries

• Dentist in Clifton, TX
• Providers in Clifton, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.