Sarah Al Kukash
Individual provider Active NPI Pediatric Dentistry · Manvel, TX
NPI 1104438092 · NPPES record last updated Oct 9, 2023
Key facts
- NPI
- 1104438092
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 36694 (TX)
- Practice address
- 10447 Bailey Rd Ste 150
Manvel, TX 77578-4057 - Phone
- (281) 607-5155
- NPI assigned
- Aug 20, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36694 | TX | MD | Clinical Child & Adolescent Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 36694 | TX | Yes |
Addresses
Primary practice location
10447 Bailey Rd Ste 150
Manvel, TX 77578-4057
Mailing address
10447 Bailey Rd Ste 150
Manvel, TX 77578-4057
Phone (281) 607-5155
Other providers in Manvel, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.