Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D3545 | AZ |
NPI | 1073665808 |
---|---|
Provider Name | Dr. John R Kurtz |
First Address | Glendale, AZ 85308 |
Second Address | Glendale, AZ 85308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |