Provider Demographics
NPI:1255570040
Name:KOVACH, TODD AUSTIN (DDS, MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:AUSTIN
Last Name:KOVACH
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4969 E INTERSTATE 20 SERVICE RD N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087
Mailing Address - Country:US
Mailing Address - Phone:817-441-5000
Mailing Address - Fax:817-441-5003
Practice Address - Street 1:4969 E INTERSTATE 20 SERVICE RD N
Practice Address - Street 2:SUITE 108
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3220
Practice Address - Country:US
Practice Address - Phone:817-441-5000
Practice Address - Fax:817-441-5003
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2017-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX239251223S0112X
TXQ1436204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery