Provider Demographics
NPI:1558954693
Name:COURTNEY, DANIELLE ANNE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:ANNE
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 S JEFFERSON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3163
Mailing Address - Country:US
Mailing Address - Phone:208-874-2807
Mailing Address - Fax:
Practice Address - Street 1:914 S JEFFERSON ST APT 1
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3163
Practice Address - Country:US
Practice Address - Phone:208-874-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist