Provider Demographics
NPI:1801416425
Name:COLLES, COURTNEY (DDS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:COLLES
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 1:3803 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9330
Mailing Address - Country:US
Mailing Address - Phone:614-864-2466
Mailing Address - Fax:
Practice Address - Street 1:3803 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9330
Practice Address - Country:US
Practice Address - Phone:614-864-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist