Healthcare Provider Details

I. General information

NPI: 1851461800
Provider Name (Legal Business Name): DOUGLAS C KURTZ GENERAL DENTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MARKET ST
MARTINSBURG PA
16662-1004
US

IV. Provider business mailing address

RD 1 BOX 506A
ROARING SPRING PA
16673
US

V. Phone/Fax

Practice location:
  • Phone: 814-793-2713
  • Fax:
Mailing address:
  • Phone: 814-224-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS027366O
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: