Provider Demographics
NPI:1518019132
Name:HARRELL, CURTIS KEVIN (DDS,PC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:KEVIN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1407
Mailing Address - Country:US
Mailing Address - Phone:636-528-6820
Mailing Address - Fax:636-462-3226
Practice Address - Street 1:411 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1407
Practice Address - Country:US
Practice Address - Phone:636-528-6820
Practice Address - Fax:636-462-3226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO144671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice