Healthcare Provider Details

I. General information

NPI: 1275746307
Provider Name (Legal Business Name): SU-MEI KUO HUANG D.M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S BUCKNER BLVD STE 223
DALLAS TX
75217-1766
US

IV. Provider business mailing address

3809 SKYLINE DR
PLANO TX
75025-2034
US

V. Phone/Fax

Practice location:
  • Phone: 214-391-6869
  • Fax: 214-391-6874
Mailing address:
  • Phone: 254-413-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: