=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013667310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEN D CURTIS, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2022
-----------------------------------------------------
Last Update Date | 03/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17260 I-20 FRONTAGE RD.
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 430-340-5015
-----------------------------------------------------
Fax | 430-340-5025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36420 STATE HIGHWAY 64
-----------------------------------------------------
City | WILLS POINT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75169-7406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-754-0828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BENJAMIN CURTIS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 972-754-0828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------