Provider Demographics
NPI:1376772103
Name:KURTH, JADA IRENE (DDS)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:IRENE
Last Name:KURTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:IRENE
Other - Last Name:AGNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:125 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1130
Mailing Address - Country:US
Mailing Address - Phone:563-336-3221
Mailing Address - Fax:563-336-3229
Practice Address - Street 1:500 W RIVER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3229
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist