Provider Demographics
NPI:1477518181
Name:NOTARNICOLA, KURT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:NOTARNICOLA
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 1:22 HOWARD BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1532
Mailing Address - Country:US
Mailing Address - Phone:973-601-0606
Mailing Address - Fax:973-601-1444
Practice Address - Street 1:22 HOWARD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1532
Practice Address - Country:US
Practice Address - Phone:973-601-0606
Practice Address - Fax:973-601-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI217341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092552Medicare ID - Type UnspecifiedMEDICARE
NJV05694Medicare UPIN