MEDICARE: MR. CURTIS DAVIS DDS

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	042813	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012317	OTHER	NY	AETNA DMO
2	0133376	OTHER	NY	DORAL DENTAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	D000659-01	OTHER	NY	AMERICHOICE

General Provider Information

NPI Number	:	1801887542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS DAVIS DDS

Provider Business Mailing Address
First Line	:	5624 TILDEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-4820
Country	:	US
Telephone Number	:	718-451-5012
Fax Number	:	718-451-5037

Provider Business Practice Location Address
First Line	:	5624 TILDEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-4820
Country	:	US
Telephone Number	:	718-451-5012
Fax Number	:	718-451-5037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/26/2013

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