Provider Demographics
NPI:1891032546
Name:CURTIS, GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:CURTIS
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 1:358 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1237
Mailing Address - Country:US
Mailing Address - Phone:734-453-3160
Mailing Address - Fax:734-453-8223
Practice Address - Street 1:358 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1237
Practice Address - Country:US
Practice Address - Phone:734-453-3160
Practice Address - Fax:734-453-8223
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist