Provider Demographics
NPI:1023338860
Name:BEUSSINK, COURTNEY LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LEIGH
Last Name:BEUSSINK
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 1:103 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764
Mailing Address - Country:US
Mailing Address - Phone:573-238-3330
Mailing Address - Fax:573-238-3464
Practice Address - Street 1:103 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764
Practice Address - Country:US
Practice Address - Phone:573-238-3330
Practice Address - Fax:573-238-3464
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100161601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice