Healthcare Provider Details

I. General information

NPI: 1477114106
Provider Name (Legal Business Name): KYU HUR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 MARSH LN
CARROLLTON TX
75006-2602
US

IV. Provider business mailing address

3312 SEATON CT
FLOWER MOUND TX
75028-2651
US

V. Phone/Fax

Practice location:
  • Phone: 469-557-7565
  • Fax:
Mailing address:
  • Phone: 972-800-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: