Provider Demographics
NPI:1386761633
Name:CURTIS, RUSSELL S (DMD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:S
Last Name:CURTIS
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 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 W WINNIE LN
Practice Address - Street 2:STE 2
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2145
Practice Address - Country:US
Practice Address - Phone:775-885-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV50981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice