Provider Demographics
NPI:1992783070
Name:KORUS, IRIS V (DDS)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:V
Last Name:KORUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1956
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831
Mailing Address - Country:US
Mailing Address - Phone:432-837-5860
Mailing Address - Fax:432-837-5890
Practice Address - Street 1:2007 W. HAMLIN AVE.
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-5860
Practice Address - Fax:432-837-5890
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090943402Medicaid
TX090943402Medicaid