Provider Demographics
NPI:1558786137
Name:CURTIS, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CURTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TANGER DR
Mailing Address - Street 2:STE. 225
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-6651
Mailing Address - Country:US
Mailing Address - Phone:972-754-0828
Mailing Address - Fax:
Practice Address - Street 1:17260 I-20 FRONTAGE RD.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103
Practice Address - Country:US
Practice Address - Phone:430-340-5015
Practice Address - Fax:430-340-5025
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347900805Medicaid