Provider Demographics
NPI:1225305212
Name:KURT J MARKUSON DMD
Entity Type:Organization
Organization Name:KURT J MARKUSON DMD
Other - Org Name:CASCADE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARKUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-382-8200
Mailing Address - Street 1:839 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:ID
Mailing Address - Zip Code:83611-0760
Mailing Address - Country:US
Mailing Address - Phone:208-382-8200
Mailing Address - Fax:208-382-6206
Practice Address - Street 1:839 MAIN ST
Practice Address - Street 2:STE1
Practice Address - City:CASCADE
Practice Address - State:ID
Practice Address - Zip Code:83611-0760
Practice Address - Country:US
Practice Address - Phone:208-382-8200
Practice Address - Fax:208-382-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty