Provider Demographics
NPI:1700083615
Name:SHEARER, COURTNEY TYLER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:TYLER
Last Name:SHEARER
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR
Mailing Address - Street 2:SUITE 524
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-897-9417
Mailing Address - Fax:502-897-9419
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 524
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-897-9417
Practice Address - Fax:502-897-9419
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist