Provider Demographics
NPI:1104912070
Name:STODDARD, CURTIS T (DMD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:T
Last Name:STODDARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-4572
Mailing Address - Country:US
Mailing Address - Phone:307-324-6200
Mailing Address - Fax:307-324-6621
Practice Address - Street 1:1719 EDINBURGH ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-4572
Practice Address - Country:US
Practice Address - Phone:307-324-6200
Practice Address - Fax:307-324-6621
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58451223G0001X
IDD40361223G0001X
WY13521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807681000Medicaid