Provider Demographics
NPI:1457581472
Name:TATLOCK, CURTIS F (LD)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:F
Last Name:TATLOCK
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-4121
Mailing Address - Country:US
Mailing Address - Phone:541-523-4747
Mailing Address - Fax:
Practice Address - Street 1:2535 MYRTLE ST.
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-4121
Practice Address - Country:US
Practice Address - Phone:541-523-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10128751122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist