Provider Demographics
NPI:1285831313
Name:KURZ, ELENA E (DMD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:E
Last Name:KURZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 LANTERN HILL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7257
Mailing Address - Country:US
Mailing Address - Phone:571-338-6691
Mailing Address - Fax:770-868-8781
Practice Address - Street 1:48 PIEDMONT DR STE 302
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8132
Practice Address - Country:US
Practice Address - Phone:770-868-8788
Practice Address - Fax:770-868-8781
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice