Provider Demographics
NPI:1952451460
Name:HOUSLEY, COURTNEY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:M
Last Name:HOUSLEY
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 1:416 S MUSTANG RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7314
Mailing Address - Country:US
Mailing Address - Phone:405-265-3131
Mailing Address - Fax:405-265-2479
Practice Address - Street 1:416 S MUSTANG RD
Practice Address - Street 2:SUITE A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7314
Practice Address - Country:US
Practice Address - Phone:405-265-3131
Practice Address - Fax:405-265-2479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200062760AMedicaid