Provider Demographics
NPI:1710764733
Name:KARKOOSH, HAIDER
Entity Type:Individual
Prefix:
First Name:HAIDER
Middle Name:
Last Name:KARKOOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6068
Mailing Address - Country:US
Mailing Address - Phone:713-584-5960
Mailing Address - Fax:
Practice Address - Street 1:2495 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6068
Practice Address - Country:US
Practice Address - Phone:713-584-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL15964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist