Provider Demographics
NPI:1023028495
Name:BEDONT, CURTIS B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:B
Last Name:BEDONT
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 1:1905 SE 192ND AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7415
Mailing Address - Country:US
Mailing Address - Phone:360-335-3232
Mailing Address - Fax:
Practice Address - Street 1:1905 SE 192ND AVE
Practice Address - Street 2:STE 201
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7415
Practice Address - Country:US
Practice Address - Phone:360-335-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-35571223X0400X
WADE 601569651223X0400X
ORD94401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023028495Medicaid