Provider Demographics
NPI:1417258724
Name:DANGL, KURT S (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:S
Last Name:DANGL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1021 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1017
Mailing Address - Country:US
Mailing Address - Phone:941-232-2086
Mailing Address - Fax:941-343-3849
Practice Address - Street 1:5158 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2489
Practice Address - Country:US
Practice Address - Phone:814-868-3647
Practice Address - Fax:814-864-2715
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026495L1223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery