Provider Demographics
NPI:1497082135
Name:CURTIS FAMILY DENTAL
Entity Type:Organization
Organization Name:CURTIS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:702-398-7802
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:LOGANDALE
Mailing Address - State:NV
Mailing Address - Zip Code:89021-0220
Mailing Address - Country:US
Mailing Address - Phone:702-398-7802
Mailing Address - Fax:702-398-7803
Practice Address - Street 1:3310 NORTH MOAPA VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LOGANDALE
Practice Address - State:NV
Practice Address - Zip Code:89021-0220
Practice Address - Country:US
Practice Address - Phone:702-398-7802
Practice Address - Fax:702-398-7803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES B. CURTIS, D. D. S. LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV2387261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507416Medicaid