Provider Demographics
NPI:1295890465
Name:KURTZ, ROBERT ALAN (DDS,BSD,FAGD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:KURTZ
Suffix:
Gender:M
Credentials:DDS,BSD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 W FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2403
Mailing Address - Country:US
Mailing Address - Phone:847-568-1492
Mailing Address - Fax:
Practice Address - Street 1:6677 N LINCOLN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3619
Practice Address - Country:US
Practice Address - Phone:847-674-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A15502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist