Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 36694 | TX |
NPI | 1104438092 |
---|---|
Provider Name | Sarah Al Kukash |
First Address | Houston, TX 77005-3207 |
Second Address | Houston, TX 77005-3207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2020 |
Last Update Date | 14/09/2020 |