Provider Demographics
NPI:1942683511
Name:KIMCUC VO DDS PLLC DBA DENTIST AT ROCK CREEK
Entity Type:Organization
Organization Name:KIMCUC VO DDS PLLC DBA DENTIST AT ROCK CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMCUC
Authorized Official - Middle Name:T
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-380-5667
Mailing Address - Street 1:12609 LOUETTA RD STE B
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5136
Mailing Address - Country:US
Mailing Address - Phone:832-380-5667
Mailing Address - Fax:281-477-7289
Practice Address - Street 1:14502 SPRINGS CYPRESS RD
Practice Address - Street 2:STE 900
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:832-534-3801
Practice Address - Fax:281-477-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1881868735OtherPROVIDER/ DENTIST