Healthcare Provider Details

I. General information

NPI: 1235667403
Provider Name (Legal Business Name): JACKLYN KURTH ORTHODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 E HILLSDALE BLVD STE 200
FOSTER CITY CA
94404-1233
US

IV. Provider business mailing address

1291 E HILLSDALE BLVD STE 200
FOSTER CITY CA
94404-1233
US

V. Phone/Fax

Practice location:
  • Phone: 650-525-9440
  • Fax: 650-525-9490
Mailing address:
  • Phone: 650-525-9440
  • Fax: 650-525-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number48937
License Number StateCA

VIII. Authorized Official

Name: DR. JACKLYN KURTH
Title or Position: OWNER
Credential: DDS
Phone: 650-525-9440