Provider Demographics
NPI:1023793528
Name:COUILLARD, JOSHUA KYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:KYLE
Last Name:COUILLARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15533 EAGLE TAVERN LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3705
Mailing Address - Country:US
Mailing Address - Phone:703-825-7978
Mailing Address - Fax:
Practice Address - Street 1:1410 N LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3504
Practice Address - Country:US
Practice Address - Phone:936-441-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice