Provider Demographics
NPI:1205845435
Name:HICKERSON-KURTZ, SUSAN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:HICKERSON-KURTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S JACKSON ST STE 510
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3133
Mailing Address - Country:US
Mailing Address - Phone:303-388-5222
Mailing Address - Fax:303-394-9670
Practice Address - Street 1:300 S JACKSON ST STE 510
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3133
Practice Address - Country:US
Practice Address - Phone:303-388-5222
Practice Address - Fax:303-394-9670
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1531596Medicare UPIN