Healthcare Provider Details

I. General information

NPI: 1790248904
Provider Name (Legal Business Name): KURTIS PAUL HUSSEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 MASON CORBIN CT STE 1
FORT MYERS FL
33907-7733
US

IV. Provider business mailing address

9798 OXFORD ST
NAPLES FL
34109-1618
US

V. Phone/Fax

Practice location:
  • Phone: 239-334-3636
  • Fax:
Mailing address:
  • Phone: 239-682-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: