Provider Demographics
NPI:1922237346
Name:ULLRICH, COURTNEY J (DMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:J
Last Name:ULLRICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 BELMONT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5446
Mailing Address - Country:US
Mailing Address - Phone:814-688-0861
Mailing Address - Fax:703-729-5799
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE # 208
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-729-7005
Practice Address - Fax:703-729-5799
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics