Provider Demographics
NPI:1073731170
Name:GARY D. COURTNEY, DDS, INC
Entity Type:Organization
Organization Name:GARY D. COURTNEY, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DEANE
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-682-5615
Mailing Address - Street 1:842 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1305
Mailing Address - Country:US
Mailing Address - Phone:913-682-5615
Mailing Address - Fax:913-682-0513
Practice Address - Street 1:842 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1305
Practice Address - Country:US
Practice Address - Phone:913-682-5615
Practice Address - Fax:913-682-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS70141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1346371341OtherDR. NOWLIN INDIV. NPI
KS1225016223OtherDR. COURTNEY INDIV NPI