Provider Demographics
NPI:1245369032
Name:KU, DAVID M (DDS,PLLC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KU
Suffix:
Gender:M
Credentials:DDS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice