=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558448043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEROME CLAYTON CURETON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6132 ALLISONVILLE RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46220-4608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-259-7310
-----------------------------------------------------
Fax | 317-259-7321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9148 ANCHOR MARK DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46236-9346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-826-0654
-----------------------------------------------------
Fax | 317-259-7321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12009713
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------