Provider Demographics
NPI:1699114413
Name:DEJARNATTE, CURTIS ALLEN (DMD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:ALLEN
Last Name:DEJARNATTE
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 1:2303 STARMOUNT CIR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3817
Mailing Address - Country:US
Mailing Address - Phone:256-533-9035
Mailing Address - Fax:
Practice Address - Street 1:2303 STARMOUNT CIR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3817
Practice Address - Country:US
Practice Address - Phone:256-533-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60111223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist