Provider Demographics
NPI:1679701148
Name:DESKUS, COURTNEY SIPE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:SIPE
Last Name:DESKUS
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 1:308 MORNING DEW LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9061
Mailing Address - Country:US
Mailing Address - Phone:704-649-4279
Mailing Address - Fax:
Practice Address - Street 1:10310 COULOAK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7672
Practice Address - Country:US
Practice Address - Phone:704-399-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist