Provider Demographics
NPI:1861948911
Name:SMALL, COURTNEY MAY (DMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MAY
Last Name:SMALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:125 N LONGPORT CIR APT E
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3403
Mailing Address - Country:US
Mailing Address - Phone:704-649-7542
Mailing Address - Fax:
Practice Address - Street 1:2620 S SEACREST BLVD STE C
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7534
Practice Address - Country:US
Practice Address - Phone:561-732-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10387122300000X
FLDN238111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist