Healthcare Provider Details

I. General information

NPI: 1205015385
Provider Name (Legal Business Name): LEIGH BAYER CURTIS DMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOLLYWOOD BLVD SE
FORT WALTON BEACH FL
32548-5765
US

IV. Provider business mailing address

220 HOLLYWOOD BLVD SE
FORT WALTON BEACH FL
32548-5765
US

V. Phone/Fax

Practice location:
  • Phone: 850-244-8604
  • Fax: 850-244-3272
Mailing address:
  • Phone: 850-244-8604
  • Fax: 850-244-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: