Provider Demographics
NPI:1598965105
Name:KURTZ, MARK EMERSON (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EMERSON
Last Name:KURTZ
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 1:129 APOLLO DR
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7026
Mailing Address - Country:US
Mailing Address - Phone:502-538-7838
Mailing Address - Fax:502-955-8048
Practice Address - Street 1:129 APOLLO DR
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7026
Practice Address - Country:US
Practice Address - Phone:502-538-7838
Practice Address - Fax:502-955-8048
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist