Individual
DR. KURTIS GLEN LIGHTHEART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5005 N. PIEDRAS ST., DENTAC, EL PASO, TX 79920-5001
(915) 742-5935
(915) 742-5174
Mailing address
12704 TIERRA LILY CT, EL PASO, TX 79938-5372
(580) 458-1217
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8396
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
26356
TX
Other
Enumeration date
08/16/2006
Last updated
09/16/2011
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