Provider Demographics
NPI:1083808430
Name:PESTA, KURT ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALAN
Last Name:PESTA
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 1:2323 CARLISLE ROAD
Mailing Address - Street 2:#9
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4057
Mailing Address - Country:US
Mailing Address - Phone:717-767-1932
Mailing Address - Fax:
Practice Address - Street 1:2323 CARLISLE ROAD
Practice Address - Street 2:#9
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4057
Practice Address - Country:US
Practice Address - Phone:717-767-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 026925 L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101395151 0001Medicaid