Provider Demographics
NPI:1780837666
Name:CURTIS D. LIVENGOOD DDS MS PC
Entity Type:Organization
Organization Name:CURTIS D. LIVENGOOD DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-363-2643
Mailing Address - Street 1:2727 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4871
Mailing Address - Country:US
Mailing Address - Phone:319-363-2643
Mailing Address - Fax:319-363-8886
Practice Address - Street 1:2727 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4871
Practice Address - Country:US
Practice Address - Phone:319-363-2643
Practice Address - Fax:319-363-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAV34303Medicare UPIN