Provider Demographics
NPI:1346389558
Name:DILLARD, KURT ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALAN
Last Name:DILLARD
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 1:1720 JACKSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-785-0633
Mailing Address - Fax:608-793-1799
Practice Address - Street 1:1720 JACKSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-785-0633
Practice Address - Fax:608-793-1799
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5309015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist