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General NPI Number Information
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NPI Number | 1619088986
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Entity Type | Individual
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Provider Name | MOHAMAD KOUTRACH DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 8111 CYPRESSWOOD DR SUITE 101
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City | SPRIN
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State | TX
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Zip | 77379
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Country | US
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Telephone | 281-855-7800
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Fax | 281-379-7341
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Provider Business Mailing Address
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Address Line | 4116B CHILDRESS ST
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City | HOUSTON
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State | TX
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Zip | 77005-1012
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Country | US
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Telephone | 281-855-7800
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Fax | 281-379-7341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901017307
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License Number State | MI
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