Provider Demographics
NPI:1164680047
Name:FUERSTENAU, KURT DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:DAVID
Last Name:FUERSTENAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 SW WALTERS DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9355
Mailing Address - Country:US
Mailing Address - Phone:503-492-2154
Mailing Address - Fax:
Practice Address - Street 1:1605 SW WALTERS DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9355
Practice Address - Country:US
Practice Address - Phone:503-492-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR52821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice