Provider Demographics
NPI:1396944047
Name:CURTIS, CARL BLAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:BLAINE
Last Name:CURTIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:C
Other - Middle Name:BLAINE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:14 N HALE ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029
Mailing Address - Country:US
Mailing Address - Phone:435-884-3476
Mailing Address - Fax:435-884-6790
Practice Address - Street 1:437 S BLUFF ST STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3553
Practice Address - Country:US
Practice Address - Phone:435-688-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6645984-99221223G0001X
AZD0099221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice