MEDICARE: MR. KURT GORDON BEHLMER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	1001322-15	WI

General Provider Information

NPI Number	:	1275987133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KURT GORDON BEHLMER DDS

Provider Business Mailing Address
First Line	:	816 N 67TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-3905
Country	:	US
Telephone Number	:	414-779-1058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 W WISCONSIN AVE
Second Line	:	APARTMENT 40
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2942
Country	:	US
Telephone Number	:	414-779-1058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	08/16/2021

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