Healthcare Provider Details

I. General information

NPI: 1477518181
Provider Name (Legal Business Name): KURT NOTARNICOLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOWARD BLVD SUITE 201
MOUNT ARLINGTON NJ
07856-1532
US

IV. Provider business mailing address

22 HOWARD BLVD SUITE 201
MOUNT ARLINGTON NJ
07856-1532
US

V. Phone/Fax

Practice location:
  • Phone: 973-601-0606
  • Fax: 973-601-1444
Mailing address:
  • Phone: 973-601-0606
  • Fax: 973-601-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI21734
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: