Provider Demographics
NPI:1275987133
Name:BEHLMER, KURT GORDON (DDS)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:GORDON
Last Name:BEHLMER
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 1:816 N 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3905
Mailing Address - Country:US
Mailing Address - Phone:414-779-1058
Mailing Address - Fax:
Practice Address - Street 1:2324 W WISCONSIN AVE
Practice Address - Street 2:APARTMENT 40
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2942
Practice Address - Country:US
Practice Address - Phone:414-779-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI1001322-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program