Provider Demographics
NPI:1497323240
Name:MATCHETT, COURTNEY BUELER (DDS)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BUELER
Last Name:MATCHETT
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 1:2727 ST. MARY'S AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAI
Mailing Address - State:MO
Mailing Address - Zip Code:63401
Mailing Address - Country:US
Mailing Address - Phone:573-221-1227
Mailing Address - Fax:573-221-5564
Practice Address - Street 1:2727 ST. MARY'S AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAI
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-221-1227
Practice Address - Fax:573-221-5564
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210188381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice