MEDICARE: H. PETER KU, D.D.S, P.A.

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	TX16358	TX

General Provider Information

NPI Number	:	1821106030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H. PETER KU, D.D.S, P.A.

Provider Business Mailing Address
First Line	:	3045 HAMILTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2240
Country	:	US
Telephone Number	:	817-870-0556
Fax Number	:	817-870-0570

Provider Business Practice Location Address
First Line	:	3045 HAMILTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2240
Country	:	US
Telephone Number	:	817-870-0556
Fax Number	:	817-870-0570

Authorized Official
Title or Position	:	DENTIST - PRACTICE OWNER
Name	:	DR. HARLINGTON PETER KU
Credential	:	D.D.S., P.A.
Telephone Number	:	817-870-0556

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	08/22/2020

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