Provider Demographics
NPI:1710166335
Name:CORTNEY V, DECKER, DDS
Entity Type:Organization
Organization Name:CORTNEY V, DECKER, DDS
Other - Org Name:OAKWOOD HILLS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-834-5882
Mailing Address - Street 1:3119 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7006
Mailing Address - Country:US
Mailing Address - Phone:715-834-5882
Mailing Address - Fax:
Practice Address - Street 1:3119 GOLF RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7006
Practice Address - Country:US
Practice Address - Phone:715-834-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1202G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherDENTAL