Provider Demographics
NPI:1376274944
Name:ANDERSON, KURT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:MICHAEL
Last Name:ANDERSON
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 1:20129 HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:BUCKLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64631-7168
Mailing Address - Country:US
Mailing Address - Phone:660-734-9034
Mailing Address - Fax:
Practice Address - Street 1:CHINLE COMPREHENSIVE CARE FACILITY
Practice Address - Street 2:HIGHWAY 191
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist