Healthcare Provider Details

I. General information

NPI: 1508962846
Provider Name (Legal Business Name): CURTIS ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 SMILE LN
BEDFORD IN
47421-3573
US

IV. Provider business mailing address

2610 SMILE LN
BEDFORD IN
47421-3573
US

V. Phone/Fax

Practice location:
  • Phone: 812-279-9473
  • Fax: 812-279-5069
Mailing address:
  • Phone: 812-279-9473
  • Fax: 812-279-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12009954
License Number StateIN

VIII. Authorized Official

Name: DR. TOD J CURTIS
Title or Position: OWNER
Credential:
Phone: 812-279-9473