Provider Demographics
NPI:1619185956
Name:KURTH, JACKLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:
Last Name:KURTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CARLMONT DR
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3482
Mailing Address - Country:US
Mailing Address - Phone:650-592-4850
Mailing Address - Fax:650-592-4872
Practice Address - Street 1:2100 CARLMONT DR
Practice Address - Street 2:SUITE #6
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3482
Practice Address - Country:US
Practice Address - Phone:650-592-4850
Practice Address - Fax:650-592-4872
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics