Provider Demographics
NPI:1033443486
Name:MACEK, KURT PHILIP (DDS)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:PHILIP
Last Name:MACEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 SHADOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:CO
Mailing Address - Zip Code:80535-9724
Mailing Address - Country:US
Mailing Address - Phone:970-416-6487
Mailing Address - Fax:
Practice Address - Street 1:8031 CAMPUS DELIVERY
Practice Address - Street 2:COLORADO STATE UNIVERSITY
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-8031
Practice Address - Country:US
Practice Address - Phone:970-491-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice