Provider Demographics
NPI:1538173513
Name:GIANOLA, COURTNEY M (DMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:M
Last Name:GIANOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 TURTLE LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-5060
Mailing Address - Country:US
Mailing Address - Phone:601-209-2829
Mailing Address - Fax:601-924-1317
Practice Address - Street 1:959 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5246
Practice Address - Country:US
Practice Address - Phone:601-925-9100
Practice Address - Fax:607-924-1317
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3384061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice