1306041322 NPI number — DAVID K CURTIS DMD PA

Table of content: (NPI 1306041322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306041322 NPI number — DAVID K CURTIS DMD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID K CURTIS DMD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306041322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-327-0995
Provider Business Mailing Address Fax Number:
662-327-0996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 N HARPER RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-872-3031
Provider Business Practice Location Address Fax Number:
662-510-0190
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-327-0995

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  PEDO-156-88 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100004480 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05705209 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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