Provider Demographics
NPI:1023389715
Name:KOULA, ARLYN THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:ARLYN
Middle Name:THOMAS
Last Name:KOULA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 S APOPKA VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4407
Mailing Address - Country:US
Mailing Address - Phone:407-351-7083
Mailing Address - Fax:
Practice Address - Street 1:6080 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4407
Practice Address - Country:US
Practice Address - Phone:407-351-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL94531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice