Provider Demographics
NPI:1508175845
Name:KOUR DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:KOUR DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-766-5857
Mailing Address - Street 1:7 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5106
Mailing Address - Country:US
Mailing Address - Phone:781-388-0900
Mailing Address - Fax:
Practice Address - Street 1:7 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5106
Practice Address - Country:US
Practice Address - Phone:781-388-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0192321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty