Provider Demographics
NPI:1457652125
Name:ATKINSON, COURTNEY MIKEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MIKEL
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 KANELL BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4008
Mailing Address - Country:US
Mailing Address - Phone:573-776-1355
Mailing Address - Fax:
Practice Address - Street 1:2951 KANELL BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4008
Practice Address - Country:US
Practice Address - Phone:573-776-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060182291223X0400X
IL021.0023901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics