Provider Demographics
NPI:1912104621
Name:RAHUL G. KODE DDS
Entity type:Organization
Organization Name:RAHUL G. KODE DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:GURUDAS
Authorized Official - Last Name:KODE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-753-9063
Mailing Address - Street 1:4855 E WARNER RD
Mailing Address - Street 2:SUITE B-9
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3308
Mailing Address - Country:US
Mailing Address - Phone:480-753-9063
Mailing Address - Fax:480-753-5296
Practice Address - Street 1:4855 E WARNER RD
Practice Address - Street 2:SUITE B-9
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3308
Practice Address - Country:US
Practice Address - Phone:480-753-9063
Practice Address - Fax:480-753-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty