Provider Demographics
NPI:1477016160
Name:LOUGH, COURTNEY ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:LOUGH
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 1:98 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6241
Mailing Address - Country:US
Mailing Address - Phone:304-243-9010
Mailing Address - Fax:304-243-9013
Practice Address - Street 1:98 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6241
Practice Address - Country:US
Practice Address - Phone:304-243-9010
Practice Address - Fax:304-243-9013
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV43821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice