Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 7737284-9921 | UT |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 058173 | NY |
NPI | 1104131275 |
---|---|
Provider Name | Dr. Logan Rand Curtis |
First Address | Watertown, NY 13601-7233 |
Second Address | Watertown, NY 13601-7233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 06/05/2019 |