Provider Demographics
NPI:1700987047
Name:COURTMAN, JOAN R (DMD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:R
Last Name:COURTMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ELM STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WORCESTOR
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:508-755-9231
Mailing Address - Fax:508-791-9737
Practice Address - Street 1:111 ELM STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:WORCESTOR
Practice Address - State:MA
Practice Address - Zip Code:01609
Practice Address - Country:US
Practice Address - Phone:508-755-9231
Practice Address - Fax:508-791-9737
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice