Provider Demographics
NPI:1508240656
Name:JURCAK, MATTHEW (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:JURCAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
Mailing Address - Street 2:BLDG H 2005 KNIGHT LANE
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:760-725-3213
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE BLDG H NAVY MEDICINE SUPPORT COMMAND
Practice Address - Street 2:ATTN: MEDICAL STAFF SVCS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:760-725-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30024538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist