Provider Demographics
NPI:1962888149
Name:KOVACH ORAL SURGERY, PLLC
Entity type:Organization
Organization Name:KOVACH ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:817-441-5000
Mailing Address - Street 1:4969 E INTERSTATE 20 SERVICE RD N
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3220
Mailing Address - Country:US
Mailing Address - Phone:817-441-5000
Mailing Address - Fax:817-441-5003
Practice Address - Street 1:4969 E INTERSTATE 20 SERVICE RD N
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3220
Practice Address - Country:US
Practice Address - Phone:817-441-5000
Practice Address - Fax:817-441-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty