Healthcare Provider Details

I. General information

NPI: 1811419070
Provider Name (Legal Business Name): KUDO CARE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 GRANDE BULEVAR
IRVING TX
75062-5108
US

IV. Provider business mailing address

3425 GRANDE BULEVAR
IRVING TX
75062-5108
US

V. Phone/Fax

Practice location:
  • Phone: 972-258-8354
  • Fax:
Mailing address:
  • Phone: 972-639-5836
  • Fax: 469-586-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANH QUYNH NGUYEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 469-230-8066