Provider Demographics
NPI:1053961797
Name:KURTZ, ANDREW (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KURTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 GILMAN ST # A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2431
Mailing Address - Country:US
Mailing Address - Phone:510-526-7546
Mailing Address - Fax:
Practice Address - Street 1:1313 GILMAN ST # A
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94706-2431
Practice Address - Country:US
Practice Address - Phone:510-526-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1043461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice