Provider Demographics
NPI:1346346749
Name:FICKER, KURT WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:WARREN
Last Name:FICKER
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 1:5001 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212
Mailing Address - Country:US
Mailing Address - Phone:513-351-3779
Mailing Address - Fax:513-351-3780
Practice Address - Street 1:5001 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2128
Practice Address - Country:US
Practice Address - Phone:513-351-3779
Practice Address - Fax:513-351-3780
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0164161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0502905Medicaid