Provider Demographics
NPI:1700627981
Name:CURTIS MARC STANDISH, D.M.D., P.A.
Entity type:Organization
Organization Name:CURTIS MARC STANDISH, D.M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:STANDISH-MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-269-6558
Mailing Address - Street 1:1700 EAGLE HARBOR PKWY
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8329
Mailing Address - Country:US
Mailing Address - Phone:904-269-6558
Mailing Address - Fax:
Practice Address - Street 1:1700 EAGLE HARBOR PKWY
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8329
Practice Address - Country:US
Practice Address - Phone:904-269-6558
Practice Address - Fax:904-278-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty