Provider Demographics
NPI:1538563267
Name:EKLUND, KURT JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:JOSEPH
Last Name:EKLUND
Suffix:
Gender:M
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:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-0824
Mailing Address - Country:US
Mailing Address - Phone:541-672-2747
Mailing Address - Fax:
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-0450
Practice Address - Country:US
Practice Address - Phone:541-672-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist