Provider Demographics
NPI:1538783360
Name:KURZ, MADISON (DMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KURZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 N OLD STUMP WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7623
Mailing Address - Country:US
Mailing Address - Phone:520-907-8474
Mailing Address - Fax:
Practice Address - Street 1:5757 W THUNDERBIRD RD STE W300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-5605
Practice Address - Country:US
Practice Address - Phone:602-439-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist