Provider Demographics
NPI:1295849107
Name:PON, CURTIS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:P
Last Name:PON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 LAGUNA BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4149
Mailing Address - Country:US
Mailing Address - Phone:916-684-4888
Mailing Address - Fax:916-684-6999
Practice Address - Street 1:5030 LAGUNA BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4149
Practice Address - Country:US
Practice Address - Phone:916-684-4888
Practice Address - Fax:916-684-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist