Healthcare Provider Details

I. General information

NPI: 1275987133
Provider Name (Legal Business Name): KURT GORDON BEHLMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W WISCONSIN AVE APARTMENT 40
MILWAUKEE WI
53233-2942
US

IV. Provider business mailing address

816 N 67TH ST
WAUWATOSA WI
53213-3905
US

V. Phone/Fax

Practice location:
  • Phone: 414-779-1058
  • Fax:
Mailing address:
  • Phone: 414-779-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1001322-15
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: