MEDICARE: CURTIS MARC STANDISH, D.M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1700627981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CURTIS MARC STANDISH, D.M.D., P.A.

Provider Business Mailing Address
First Line	:	1700 EAGLE HARBOR PKWY
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8329
Country	:	US
Telephone Number	:	904-269-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 EAGLE HARBOR PKWY
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8329
Country	:	US
Telephone Number	:	904-269-6558
Fax Number	:	904-278-9292

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	DR. KELLY THERESA STANDISH-MAYO
Credential	:	DMD
Telephone Number	:	904-269-6558

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	10/03/2024

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