Healthcare Provider Details

I. General information

NPI: 1780664870
Provider Name (Legal Business Name): CURTIS D LIVENGOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 FIRST AVE SE
CEDAR RAPIDS IA
52402
US

IV. Provider business mailing address

2727 FIRST AVE SE
CEDAR RAPIDS IA
52402
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-2643
  • Fax: 319-363-8886
Mailing address:
  • Phone: 319-363-2643
  • Fax: 319-363-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5515
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: