Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5263 | AL |
NPI | 1053349472 |
---|---|
Provider Name | Dr. Jonathan C Curtis |
First Address | Birmingham, AL 35242-8627 |
Second Address | Birmingham, AL 35242-8627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009934268 | (05) | AL |
515-31019 | BC/BS ID # (01) | AL |