Healthcare Provider Details

I. General information

NPI: 1679277131
Provider Name (Legal Business Name): KOUDER DAKHLALLAH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45267-1510
US

IV. Provider business mailing address

200 ALBERT SABIN WAY OFC 2220
CINCINNATI OH
45267-2800
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-2586
  • Fax: 513-584-1125
Mailing address:
  • Phone: 513-584-2586
  • Fax: 513-584-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: