Provider Demographics
NPI:1417190950
Name:COUCH, DECK FRANKLIN (DDS)
Entity Type:Individual
Prefix:
First Name:DECK
Middle Name:FRANKLIN
Last Name:COUCH
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 1:4627 N DAVIS HWY
Mailing Address - Street 2:BUILDING A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2364
Mailing Address - Country:US
Mailing Address - Phone:850-477-1120
Mailing Address - Fax:850-477-1062
Practice Address - Street 1:4627 N DAVIS HWY
Practice Address - Street 2:BUILDING A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2364
Practice Address - Country:US
Practice Address - Phone:850-477-1120
Practice Address - Fax:850-477-1062
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 45471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics