Provider Demographics
NPI:1922234244
Name:VILLARI, COURTNEY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:R
Last Name:VILLARI
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 1:7700 MADISON STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305
Mailing Address - Country:US
Mailing Address - Phone:708-689-0419
Mailing Address - Fax:
Practice Address - Street 1:7700 MADISON ST
Practice Address - Street 2:SUITE #1
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2102
Practice Address - Country:US
Practice Address - Phone:708-689-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist