Provider Demographics
NPI:1447209259
Name:COURTER, NYLA J (DDS)
Entity Type:Individual
Prefix:
First Name:NYLA
Middle Name:J
Last Name:COURTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9786 W DELPHI PIKE 27
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:IN
Mailing Address - Zip Code:46919-9574
Mailing Address - Country:US
Mailing Address - Phone:765-395-3555
Mailing Address - Fax:765-395-3141
Practice Address - Street 1:9786 W DELPHI PIKE 27
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:IN
Practice Address - Zip Code:46919-9574
Practice Address - Country:US
Practice Address - Phone:765-395-3555
Practice Address - Fax:765-395-3141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice