Provider Demographics
NPI:1336227271
Name:CURTIS E. WAITES, D.D.S., P.C.
Entity type:Organization
Organization Name:CURTIS E. WAITES, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WAITES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:478-825-2314
Mailing Address - Street 1:607 BLUEBIRD BLVD
Mailing Address - Street 2:P.O. BOX 717
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-5082
Mailing Address - Country:US
Mailing Address - Phone:478-825-2314
Mailing Address - Fax:478-825-2338
Practice Address - Street 1:607 BLUEBIRD BLVD
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-5082
Practice Address - Country:US
Practice Address - Phone:478-825-2314
Practice Address - Fax:478-825-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty