Provider Demographics
NPI:1942417043
Name:CURTIS, HOMER MILTON (DMD)
Entity type:Individual
Prefix:DR
First Name:HOMER
Middle Name:MILTON
Last Name:CURTIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VAN DEENE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3258
Mailing Address - Country:US
Mailing Address - Phone:413-734-0476
Mailing Address - Fax:413-746-4766
Practice Address - Street 1:75 VAN DEENE AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3258
Practice Address - Country:US
Practice Address - Phone:413-734-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice