Provider Demographics
NPI:1619467479
Name:KILLOUGH, COURTNEY ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELLEN
Last Name:KILLOUGH
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 1:1953 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3629
Mailing Address - Country:US
Mailing Address - Phone:757-320-9303
Mailing Address - Fax:
Practice Address - Street 1:18455 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2822
Practice Address - Country:US
Practice Address - Phone:408-778-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014160341223G0001X
CADDS1044741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice