Healthcare Provider Details

I. General information

NPI: 1437258365
Provider Name (Legal Business Name): MICHAEL D. COUCHOT DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL D. COUCHOT DMD, MD

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 CARTER AVE
ASHLAND KY
41101-1917
US

IV. Provider business mailing address

2844 CARTER AVE
ASHLAND KY
41101-1917
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-1115
  • Fax: 606-325-4639
Mailing address:
  • Phone: 606-329-1115
  • Fax: 606-325-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number34851
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6989
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: