Provider Demographics
NPI:1356718795
Name:MANN, COURTNEY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANN
Last Name:MANN
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 1:6661 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3040
Mailing Address - Country:US
Mailing Address - Phone:608-836-1446
Mailing Address - Fax:608-836-0339
Practice Address - Street 1:6661 UNIVERSITY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3040
Practice Address - Country:US
Practice Address - Phone:608-836-1446
Practice Address - Fax:608-836-0339
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001198-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist