Healthcare Provider Details

I. General information

NPI: 1205328085
Provider Name (Legal Business Name): CURTIS A THIBEAULT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 09/02/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 MAIN STREET
ALTON NH
03809
US

IV. Provider business mailing address

40 WINTER ST STE 201
ROCHESTER NH
03867-3139
US

V. Phone/Fax

Practice location:
  • Phone: 603-855-2017
  • Fax:
Mailing address:
  • Phone: 603-332-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04412
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: