Provider Demographics
NPI:1720191695
Name:KURKOWSKI, GEORGE JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:KURKOWSKI
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 1:24 JAY ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1900
Mailing Address - Country:US
Mailing Address - Phone:518-382-7517
Mailing Address - Fax:518-382-5570
Practice Address - Street 1:24 JAY ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1900
Practice Address - Country:US
Practice Address - Phone:518-382-7517
Practice Address - Fax:518-382-5570
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00768947Medicaid
NY10005119OtherCDPHP
NY000460188001OtherBLUE SHIELD