Healthcare Provider Details

I. General information

NPI: 1912717877
Provider Name (Legal Business Name): UNKNOWN ELSA KURIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 MAIN ST
GREEN BAY WI
54302-3920
US

IV. Provider business mailing address

2100 N URSULA ST UNIT 224
AURORA CO
80045-7409
US

V. Phone/Fax

Practice location:
  • Phone: 920-499-2770
  • Fax:
Mailing address:
  • Phone: 703-862-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001729
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: