=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093372112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH CURLEY DMD & ASSOCIATES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2019
-----------------------------------------------------
Last Update Date | 05/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 POOLE RD UNIT C
-----------------------------------------------------
City | BELVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28451-1248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-463-2267
-----------------------------------------------------
Fax | 910-660-8135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 POOLE RD UNIT C
-----------------------------------------------------
City | BELVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28451-1248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-463-2267
-----------------------------------------------------
Fax | 910-660-8135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | MRS. JEANNETTE DANIELS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-403-8778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------