Provider Demographics
NPI:1952590143
Name:KURTICH, INNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:KURTICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 BEVERLY BLVD APT 348
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2748
Mailing Address - Country:US
Mailing Address - Phone:323-240-4960
Mailing Address - Fax:
Practice Address - Street 1:824 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4010
Practice Address - Country:US
Practice Address - Phone:323-240-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist