Provider Demographics
NPI:1427019884
Name:KURTZ, JACK ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ALLAN
Last Name:KURTZ
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 1:1220 W GLENOAKS BLVD
Mailing Address - Street 2:204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2231
Mailing Address - Country:US
Mailing Address - Phone:818-247-8132
Mailing Address - Fax:818-247-3152
Practice Address - Street 1:1220 W GLENOAKS BLVD
Practice Address - Street 2:204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2231
Practice Address - Country:US
Practice Address - Phone:818-247-8132
Practice Address - Fax:818-247-3152
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist