Provider Demographics
NPI:1144338567
Name:COURTNEY, CARRIE L (DDS)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:L
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 QUARRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-342-8701
Mailing Address - Fax:304-352-8702
Practice Address - Street 1:1321 QUARRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-342-8701
Practice Address - Fax:304-352-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice