MEDICARE: DR. BARRY D KURTZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	024534-1	NY

General Provider Information

NPI Number	:	1053313148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY D KURTZ DDS

Provider Business Mailing Address
First Line	:	1951 BAY BLVD
Second Line	:
City	:	ATLANTIC BEACH
State	:	NY
Zip	:	11509-1305
Country	:	US
Telephone Number	:	516-239-3259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 BEACH 105TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2699
Country	:	US
Telephone Number	:	718-474-0007
Fax Number	:	718-474-0004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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