Provider Demographics
NPI:1629638713
Name:STRUBIN, COURTNEY ANNE
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANNE
Last Name:STRUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 SOUTHPORT SUPPLY RD SE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-7943
Mailing Address - Country:US
Mailing Address - Phone:910-933-2408
Mailing Address - Fax:910-814-4198
Practice Address - Street 1:3071 SOUTHPORT SUPPLY RD SE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-7943
Practice Address - Country:US
Practice Address - Phone:910-933-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice