Provider Demographics
NPI:1679277131
Name:DAKHLALLAH, KOUDER (DDS)
Entity type:Individual
Prefix:DR
First Name:KOUDER
Middle Name:
Last Name:DAKHLALLAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ALBERT SABIN WAY OFC 2220
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-2800
Mailing Address - Country:US
Mailing Address - Phone:513-584-2586
Mailing Address - Fax:513-584-1125
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-1510
Practice Address - Country:US
Practice Address - Phone:513-584-2586
Practice Address - Fax:513-584-1125
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program