Provider Demographics
NPI:1699875302
Name:HEUERMAN, KURT CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:CHARLES
Last Name:HEUERMAN
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 1:4450 W WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4093
Mailing Address - Country:US
Mailing Address - Phone:248-674-0495
Mailing Address - Fax:248-674-4308
Practice Address - Street 1:4450 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4093
Practice Address - Country:US
Practice Address - Phone:248-674-0495
Practice Address - Fax:248-674-4308
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist