Provider Demographics
NPI:1093081267
Name:EVA Y. KU, DMD, PC
Entity Type:Organization
Organization Name:EVA Y. KU, DMD, PC
Other - Org Name:BLUE RIDGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-475-0602
Mailing Address - Street 1:206 AMIABLE LOOP
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5579
Mailing Address - Country:US
Mailing Address - Phone:919-475-0602
Mailing Address - Fax:919-869-2351
Practice Address - Street 1:2801 BLUE RIDGE RD STE G10
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6474
Practice Address - Country:US
Practice Address - Phone:919-781-3862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty