Provider Demographics
NPI:1457696163
Name:DAVID M. KU DDS PLLC
Entity Type:Organization
Organization Name:DAVID M. KU DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-434-9494
Mailing Address - Street 1:555 MANCO RD STE B
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3640
Mailing Address - Country:US
Mailing Address - Phone:972-434-9494
Mailing Address - Fax:972-436-9495
Practice Address - Street 1:555 MANCO RD STE B
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3640
Practice Address - Country:US
Practice Address - Phone:972-434-9494
Practice Address - Fax:972-436-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306508Medicaid