MEDICARE: DAVID M. KU DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457696163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID M. KU DDS PLLC

Provider Business Mailing Address
First Line	:	555 MANCO RD STE B
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3640
Country	:	US
Telephone Number	:	972-434-9494
Fax Number	:	972-436-9495

Provider Business Practice Location Address
First Line	:	555 MANCO RD STE B
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3640
Country	:	US
Telephone Number	:	972-434-9494
Fax Number	:	972-436-9495

Authorized Official
Title or Position	:	GENERAL DENTISTRY
Name	:	DR. DAVID M KU
Credential	:	DDS
Telephone Number	:	972-434-9494

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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