Provider Demographics
NPI:1275640898
Name:SCHEETZ, KURT THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:THOMAS
Last Name:SCHEETZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E BAY STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:910-457-0224
Mailing Address - Fax:
Practice Address - Street 1:1301 N HOWE STREET
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-457-5061
Practice Address - Fax:910-457-4707
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97612OtherBCBS NC
NC8997612Medicaid
NC680962OtherUNITED CONCORDIA