Provider Demographics
NPI:1083823231
Name:COURTAD, JEANETTE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARIE
Last Name:COURTAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JEANETTE
Other - Middle Name:FLANNERY
Other - Last Name:COURTAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:623 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1904
Mailing Address - Country:US
Mailing Address - Phone:303-278-9733
Mailing Address - Fax:
Practice Address - Street 1:623 14TH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1904
Practice Address - Country:US
Practice Address - Phone:303-278-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist