Provider Demographics
NPI:1679927792
Name:CARTER, COURTNEY A W (RDH)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A W
Last Name:CARTER
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:GEBAEUDE 250
Mailing Address - Street 2:USAG BAVARIA ROSE BARRACKS
Mailing Address - City:VILSECK
Mailing Address - State:BAYERN
Mailing Address - Zip Code:92249
Mailing Address - Country:DE
Mailing Address - Phone:4963719-464-2500
Mailing Address - Fax:
Practice Address - Street 1:GEBAEUDE 250
Practice Address - Street 2:USAG BAVARIA ROSE BARRACKS
Practice Address - City:VILSECK
Practice Address - State:BAYERN
Practice Address - Zip Code:92249
Practice Address - Country:DE
Practice Address - Phone:4963719-464-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012011620124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist