Provider Demographics
NPI:1558448399
Name:KURILEC, MARTHA ANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANNA
Last Name:KURILEC
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 1:21 SILO DRIVE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2717
Mailing Address - Country:US
Mailing Address - Phone:860-529-3435
Mailing Address - Fax:860-529-3597
Practice Address - Street 1:705 NEW BRITAIN AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-527-2999
Practice Address - Fax:860-529-3597
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice