Provider Demographics
NPI:1386017481
Name:D. KENNON CURTIS JR. DMD PC
Entity type:Organization
Organization Name:D. KENNON CURTIS JR. DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENNON
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-325-6595
Mailing Address - Street 1:7771 HIGHWAY 72 W
Mailing Address - Street 2:STE B
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7771 HIGHWAY 72 W
Practice Address - Street 2:STE B
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8813
Practice Address - Country:US
Practice Address - Phone:256-325-6595
Practice Address - Fax:256-325-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6217 C11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1487939435OtherINDIVIDUAL NPI