MEDICARE: DR. MENAKSHY KOUL D.D.S., M.S.

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	1223P0300X	Periodontics	3717	WV

General Provider Information

NPI Number	:	1609915677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MENAKSHY KOUL D.D.S., M.S.

Provider Business Mailing Address
First Line	:	2000 HAMPTON CTR STE A
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1704
Country	:	US
Telephone Number	:	304-599-9558
Fax Number	:	304-599-9559

Provider Business Practice Location Address
First Line	:	2000 HAMPTON CTR STE A
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1704
Country	:	US
Telephone Number	:	304-599-9558
Fax Number	:	304-599-9559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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