Provider Demographics
NPI:1659530798
Name:WILSON, COURTNEY CHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:CHAD
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 W PARMER LN STE 606
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-6807
Mailing Address - Country:US
Mailing Address - Phone:512-918-0888
Mailing Address - Fax:
Practice Address - Street 1:6301 W PARMER LN STE 606
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-6807
Practice Address - Country:US
Practice Address - Phone:512-918-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist