Provider Demographics
NPI:1205328085
Name:THIBEAULT, CURTIS A (DMD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:A
Last Name:THIBEAULT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WINTER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3139
Mailing Address - Country:US
Mailing Address - Phone:603-332-7300
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809
Practice Address - Country:US
Practice Address - Phone:603-855-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist