Provider Demographics
NPI:1659632412
Name:IRIS V. KORUS DDS INC.
Entity Type:Organization
Organization Name:IRIS V. KORUS DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:KORUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-467-2064
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:100-102 E. CALIFORNIA AVE.
Mailing Address - City:VALENTINE
Mailing Address - State:TX
Mailing Address - Zip Code:79854-0098
Mailing Address - Country:US
Mailing Address - Phone:432-467-2064
Mailing Address - Fax:
Practice Address - Street 1:100-102 E. CALIFORNIA AVE.
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:TX
Practice Address - Zip Code:79854-0098
Practice Address - Country:US
Practice Address - Phone:432-467-2064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11995261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090943402Medicaid