Provider Demographics
NPI:1306825476
Name:MARTIN, KURT F (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:F
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2152
Mailing Address - Country:US
Mailing Address - Phone:785-628-1079
Mailing Address - Fax:785-628-1090
Practice Address - Street 1:2901 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2152
Practice Address - Country:US
Practice Address - Phone:785-628-1079
Practice Address - Fax:785-628-1090
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059876Medicare PIN
KSG84250Medicare UPIN