Provider Demographics
NPI:1376772103
Name:KURTH, JADA IRENE (DDS)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:IRENE
Last Name:KURTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:IRENE
Other - Last Name:AGNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2928 HAMILTON BLVD UPPR E
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2424
Mailing Address - Country:US
Mailing Address - Phone:712-255-5754
Mailing Address - Fax:712-224-2075
Practice Address - Street 1:2928 HAMILTON BLVD UPPR E
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2424
Practice Address - Country:US
Practice Address - Phone:712-255-5754
Practice Address - Fax:712-224-2075
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist