Healthcare Provider Details

I. General information

NPI: 1558630921
Provider Name (Legal Business Name): ROBERT ALLEN CURTIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WEST 5TH AVE
NOME AK
99762
US

IV. Provider business mailing address

PO BOX 966
NOME AK
99762
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3309
  • Fax:
Mailing address:
  • Phone: 907-443-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number0515-DHAT
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: