Provider Demographics
NPI:1265402531
Name:CURTIS, DAVID MONTGOMERY (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MONTGOMERY
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 1:2855 CAMPUS DR
Mailing Address - Street 2:STE 670
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2649
Mailing Address - Country:US
Mailing Address - Phone:763-520-1234
Mailing Address - Fax:763-520-1233
Practice Address - Street 1:2855 CAMPUS DR
Practice Address - Street 2:STE 670
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2649
Practice Address - Country:US
Practice Address - Phone:763-520-1234
Practice Address - Fax:763-520-1233
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU21056Medicare UPIN
MN850000061Medicare ID - Type Unspecified
MNC01183Medicare PIN