Healthcare Provider Details

I. General information

NPI: 1790737278
Provider Name (Legal Business Name): SUSANNA KURK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CALIFORNIA DR
YOUNTVILLE CA
94599-1412
US

IV. Provider business mailing address

PO BOX 942895
SACRAMENTO CA
94295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4771
  • Fax: 707-948-2530
Mailing address:
  • Phone: 707-944-4771
  • Fax: 707-948-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: