Provider Demographics
NPI:1245421882
Name:KURLANSIK, JACK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:KURLANSIK
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 1:515 RARITAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2901
Mailing Address - Country:US
Mailing Address - Phone:732-572-4244
Mailing Address - Fax:732-572-4274
Practice Address - Street 1:515 RARITAN AVENUE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2901
Practice Address - Country:US
Practice Address - Phone:732-572-4244
Practice Address - Fax:732-572-4274
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10122871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1919709Medicaid