Provider Demographics
NPI:1326706920
Name:COUTTS, KAREN DIANE (RDH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:COUTTS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DIANE
Other - Last Name:TIBBALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:4755 PASTURE RD BLDG 299
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89496-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL AIR STATION FALLON 4755 PASTURE ROAD BLDG 299
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89496-0001
Practice Address - Country:US
Practice Address - Phone:775-426-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2734124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist