Provider Demographics
NPI:1689782880
Name:KU, HARLINGTON PETER (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:HARLINGTON
Middle Name:PETER
Last Name:KU
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2240
Mailing Address - Country:US
Mailing Address - Phone:817-870-0556
Mailing Address - Fax:817-870-0570
Practice Address - Street 1:3045 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2240
Practice Address - Country:US
Practice Address - Phone:817-870-0556
Practice Address - Fax:817-870-0570
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX163581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice