Healthcare Provider Details

I. General information

NPI: 1679704282
Provider Name (Legal Business Name): DONALD AVERY CURTIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 DURANT AVE
BERKELEY CA
94704
US

IV. Provider business mailing address

2300 DURANT AVE
BERKELEY CA
94704
US

V. Phone/Fax

Practice location:
  • Phone: 510-644-2114
  • Fax: 510-644-2154
Mailing address:
  • Phone: 510-644-2114
  • Fax: 510-644-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: