Provider Demographics
NPI:1609915677
Name:KOUL, MENAKSHY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MENAKSHY
Middle Name:
Last Name:KOUL
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HAMPTON CTR STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1704
Mailing Address - Country:US
Mailing Address - Phone:304-599-9558
Mailing Address - Fax:304-599-9559
Practice Address - Street 1:2000 HAMPTON CTR STE A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1704
Practice Address - Country:US
Practice Address - Phone:304-599-9558
Practice Address - Fax:304-599-9559
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics