Provider Demographics
NPI:1235667403
Name:JACKLYN KURTH ORTHODONTICS INC
Entity Type:Organization
Organization Name:JACKLYN KURTH ORTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-525-9440
Mailing Address - Street 1:1291 E HILLSDALE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1233
Mailing Address - Country:US
Mailing Address - Phone:650-525-9440
Mailing Address - Fax:650-525-9490
Practice Address - Street 1:1291 E HILLSDALE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1233
Practice Address - Country:US
Practice Address - Phone:650-525-9440
Practice Address - Fax:650-525-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48937261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental