Provider Demographics
NPI:1104438092
Name:AL KUKASH, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:AL KUKASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10447 BAILEY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4057
Mailing Address - Country:US
Mailing Address - Phone:281-607-5155
Mailing Address - Fax:
Practice Address - Street 1:10447 BAILEY RD STE 150
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-4057
Practice Address - Country:US
Practice Address - Phone:281-607-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry