Provider Demographics
NPI:1598821233
Name:CURREY, JACK LESLIE (DDS)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:LESLIE
Last Name:CURREY
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 1:809 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377
Mailing Address - Country:US
Mailing Address - Phone:423-886-1160
Mailing Address - Fax:
Practice Address - Street 1:809 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377
Practice Address - Country:US
Practice Address - Phone:423-886-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000001663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0033888OtherBCBS OF TN