Provider Demographics
NPI:1487048435
Name:CFD GROUP, PLLC
Entity type:Organization
Organization Name:CFD GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:DRINKWATER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-519-2875
Mailing Address - Street 1:3202 S W S YOUNG DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6537
Mailing Address - Country:US
Mailing Address - Phone:254-519-2875
Mailing Address - Fax:
Practice Address - Street 1:3202 S W S YOUNG DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6537
Practice Address - Country:US
Practice Address - Phone:254-519-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3402653Medicaid