Provider Demographics
NPI:1194706135
Name:KIURTSIDIS, GEORGIOS (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGIOS
Middle Name:
Last Name:KIURTSIDIS
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 1:200 BRANNAN ST
Mailing Address - Street 2:#238
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-242-9999
Practice Address - Fax:415-520-9998
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics