Provider Demographics
NPI:1154549772
Name:KURTZ, SEYMOUR L (DMD)
Entity type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:L
Last Name:KURTZ
Suffix:
Gender:M
Credentials:DMD
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
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2431
Mailing Address - Country:US
Mailing Address - Phone:510-526-7548
Mailing Address - Fax:510-526-1027
Practice Address - Street 1:1313 GILMAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94706-2431
Practice Address - Country:US
Practice Address - Phone:510-526-7548
Practice Address - Fax:510-526-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice