MEDICARE: DR. CURTIS WILLIAM POOLE 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	1223G0001X	General Practice Dentistry	3513	WV

General Provider Information

NPI Number	:	1629070818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CURTIS WILLIAM POOLE D.D.S.

Provider Business Mailing Address
First Line	:	1184 S MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1222
Country	:	US
Telephone Number	:	304-743-1724
Fax Number	:	304-743-1725

Provider Business Practice Location Address
First Line	:	1184 S MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1222
Country	:	US
Telephone Number	:	304-743-1724
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/30/2011

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