Basic Information
| Provider Information | |||||||||
| NPI: | 1376274944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20129 HIGHWAY 129 | ||||||||
| Address2: | |||||||||
| City: | BUCKLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646317168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607349034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CHINLE COMPREHENSIVE CARE FACILITY | ||||||||
| Address2: | HIGHWAY 191 | ||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286747001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2022 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2022018760 | MO | Y | Dental Providers | Dentist |
No ID Information.