Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS026495L | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS026495L | PA |
NPI | 1417258724 |
---|---|
Provider Name | Dr. Kurt S Dangl |
First Address | Erie, PA 16507-1017 |
Second Address | Erie, PA 16509-2489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2010 |
Last Update Date | 20/07/2015 |