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NPI Code Detail

MEDICARE: MICHAEL A KORT DDS

MEDICARE:   MICHAEL A KORT  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
11223P0221XPediatric DentistryD5432AZ

General Provider Information

NPI Number : 1669431482
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL A KORT DDS
Provider Business Mailing Address
First Line : 1751 N STOCKTON HILL RD
Second Line :
City : KINGMAN
State : AZ
Zip : 86401-6601
Country : US
Telephone Number : 928-718-8668
Fax Number : 928-718-2106
Provider Business Practice Location Address
First Line : 1751 N STOCKTON HILL RD
Second Line :
City : KINGMAN
State : AZ
Zip : 86401-6601
Country : US
Telephone Number : 928-718-8668
Fax Number : 928-718-2106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 07/08/2007

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Directions to “ MICHAEL A KORT DDS” Practice Location

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