Provider Demographics
NPI:1417021312
Name:CRAIG E KOVACH DDS INC
Entity Type:Organization
Organization Name:CRAIG E KOVACH DDS INC
Other - Org Name:FIRST DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUISTION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-372-6062
Mailing Address - Street 1:1243 E RED BIRD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-2008
Mailing Address - Country:US
Mailing Address - Phone:214-372-6062
Mailing Address - Fax:214-372-9635
Practice Address - Street 1:1243 E RED BIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-2008
Practice Address - Country:US
Practice Address - Phone:214-372-6062
Practice Address - Fax:214-372-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental