Provider Demographics
NPI:1194206862
Name:LISH, COURTNEY ELIZABETH (DDS)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:LISH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:LAFORTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:828 HARRISBURG DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3214
Mailing Address - Country:US
Mailing Address - Phone:256-800-9950
Mailing Address - Fax:
Practice Address - Street 1:1920 SLAUGHTER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8619
Practice Address - Country:US
Practice Address - Phone:256-830-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00065671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice