Healthcare Provider Details

I. General information

NPI: 1306973896
Provider Name (Legal Business Name): HARRY T. KU D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MIDDLESEX RD SUITE D-3B
TYNGSBORO MA
01879-1070
US

IV. Provider business mailing address

440 MIDDLESEX RD SUITE D-3B
TYNGSBORO MA
01879-1070
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-8526
  • Fax: 978-649-8527
Mailing address:
  • Phone: 978-649-8526
  • Fax: 978-649-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13704
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: