MEDICARE: DR. BENJAMIN DAVID CURTIS D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D13233	MN

General Provider Information

NPI Number	:	1619314531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN DAVID CURTIS D.D.S

Provider Business Mailing Address
First Line	:	7806 MARKET BLVD
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9440
Country	:	US
Telephone Number	:	952-949-1083
Fax Number	:

Provider Business Practice Location Address
First Line	:	7806 MARKET BLVD
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9440
Country	:	US
Telephone Number	:	952-949-1083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2013
Last Update Date	:	12/11/2014

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