Provider Demographics
NPI:1063904944
Name:KO, JANICE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:KO
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 1:1515 W NC HIGHWAY 54 STE 260
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6700
Mailing Address - Country:US
Mailing Address - Phone:919-493-5714
Mailing Address - Fax:
Practice Address - Street 1:1515 W NC HIGHWAY 54 STE 260
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6700
Practice Address - Country:US
Practice Address - Phone:919-493-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist