Provider Demographics
NPI:1831199447
Name:CURTIS, THOMAS R (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
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 1:3224 N MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4214
Mailing Address - Country:US
Mailing Address - Phone:208-375-0600
Mailing Address - Fax:208-375-0647
Practice Address - Street 1:3224 N MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4214
Practice Address - Country:US
Practice Address - Phone:208-375-0600
Practice Address - Fax:208-375-0647
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist