Provider Demographics
NPI:1588821128
Name:GURSTEIN, KENNETH WILLIAM (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:GURSTEIN
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:6400 CANOGA AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:818-592-0875
Mailing Address - Fax:818-766-9514
Practice Address - Street 1:6400 CANOGA AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:818-592-0875
Practice Address - Fax:818-766-9514
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA374251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics