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Organization
KELLY P COUCH DDS INC
Active
Organization
KELLY P COUCH DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY P COUCH DDS (OWNER)
(916) 683-2300
Entity
Organization
Contact information
Practice address
7915 LAGUNA BLVD, SUITE #110, ELK GROVE, CA 95758-7945
(916) 683-2300
(916) 683-2352
Mailing address
7915 LAGUNA BLVD, SUITE #110, ELK GROVE, CA 95758-7945
(916) 683-2300
(916) 683-2352
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
29029
CA
Other
Enumeration date
04/11/2007
Last updated
08/22/2020
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