MEDICARE: E M KOURI DDS MSD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	7179	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144419821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E M KOURI DDS MSD PLLC

Provider Business Mailing Address
First Line	:	2921 LACKLAND RD
Second Line	:	SUITE 201
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4173
Country	:	US
Telephone Number	:	817-732-2821
Fax Number	:	817-763-0419

Provider Business Practice Location Address
First Line	:	2921 LACKLAND RD
Second Line	:	SUITE 201
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4173
Country	:	US
Telephone Number	:	817-732-2821
Fax Number	:	817-763-0419

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EUGENE M KOURI
Credential	:	DDS,MSD
Telephone Number	:	817-732-2821

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/02/2012

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