Kurtis Homan
Individual provider Active NPI Dentist · Coldwater, OH
NPI 1437538899 · NPPES record last updated May 19, 2015
Key facts
- NPI
- 1437538899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 30.024449 (OH)
- Practice address
- 750 W Main St
Coldwater, OH 45828-1611 - Phone
- (419) 678-4806
- NPI assigned
- May 19, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 30, 2015 through Dec 30, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.024449 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coldwater Dental Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.024449 | OH | Yes |
Addresses
Primary practice location
750 W Main St
Coldwater, OH 45828-1611
Mailing address
750 W Main St
PO Box 68
Coldwater, OH 45828-1611
Phone (419) 678-4806
Other providers in Coldwater, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.