Provider Demographics
NPI:1710451141
Name:KOUDDS TEXAS PLLC
Entity Type:Organization
Organization Name:KOUDDS TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-704-9314
Mailing Address - Street 1:615 MAIN ST STE 113
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-4315
Mailing Address - Country:US
Mailing Address - Phone:469-353-6964
Mailing Address - Fax:
Practice Address - Street 1:615 MAIN ST.
Practice Address - Street 2:SUITE 113
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:716-704-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental