Provider Demographics
NPI:1912030586
Name:WEBER, KURT KENTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:KENTON
Last Name:WEBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4572
Mailing Address - Country:US
Mailing Address - Phone:813-689-9100
Mailing Address - Fax:813-653-4990
Practice Address - Street 1:1012 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4572
Practice Address - Country:US
Practice Address - Phone:813-689-9100
Practice Address - Fax:813-653-4990
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice