Provider Demographics
NPI:1245265198
Name:H'DOUBLER, KURT E (DDS)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:E
Last Name:H'DOUBLER
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 1:1722 S GLENSTONE AVE STE SS
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1517
Mailing Address - Country:US
Mailing Address - Phone:417-864-5366
Mailing Address - Fax:417-890-9903
Practice Address - Street 1:1722 S GLENSTONE AVE STE SS
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1517
Practice Address - Country:US
Practice Address - Phone:417-864-5366
Practice Address - Fax:417-890-9903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice