Provider Demographics
NPI:1942498175
Name:J. R. COURTMAN DMD
Entity Type:Organization
Organization Name:J. R. COURTMAN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:R
Authorized Official - Last Name:COURTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-755-9231
Mailing Address - Street 1:111 ELM ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1967
Mailing Address - Country:US
Mailing Address - Phone:508-755-9231
Mailing Address - Fax:
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1967
Practice Address - Country:US
Practice Address - Phone:508-755-9231
Practice Address - Fax:508-791-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty