Dewitt Dental Professionals

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22869 Issued in TX

Legal business name

DEWITT DENTAL PROFESSIONALS

Practice address

1707 W Main St
Yorktown, TX 78164-5127

Phone

(361) 564-2239

NPI assigned

Mar 27, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Marie Koenig, D.D.S.

Title

Managing Member

Phone

(361) 243-6242

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1376819029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "CUERO",
            "state": "TX",
            "postal_code": "779540590",
            "telephone_number": "361-564-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W MAIN ST",
            "city": "YORKTOWN",
            "state": "TX",
            "postal_code": "781645127",
            "telephone_number": "361-564-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEWITT DENTAL PROFESSIONALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-27",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "361-243-6242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gordon Barth, D.O.
• Carolyn Dale Denton, D.O.
• Dewitt Medical District
• Dewitt Medical District
• Diversicare Leasing Corp.
• Peter Dunn
• John H Frels, D.D.S.

• General Practice Dentistry in Yorktown, TX
• Providers in Yorktown, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.