Provider Demographics
NPI:1134251515
Name:CARR, COURTNEY BETH (DDS)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BETH
Last Name:CARR
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 1:1100 KING MARK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5786
Mailing Address - Country:US
Mailing Address - Phone:214-228-3365
Mailing Address - Fax:
Practice Address - Street 1:6225 CHAPEL HILL BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6392
Practice Address - Country:US
Practice Address - Phone:972-608-4746
Practice Address - Fax:972-608-4749
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227371223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183094511Medicaid