Provider Demographics
NPI:1740352707
Name:THOMAS K. COURTNEY, DDS, UBO
Entity type:Organization
Organization Name:THOMAS K. COURTNEY, DDS, UBO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-669-3611
Mailing Address - Street 1:302 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64490-7122
Mailing Address - Country:US
Mailing Address - Phone:816-669-3611
Mailing Address - Fax:816-669-3253
Practice Address - Street 1:302 PARK AVE
Practice Address - Street 2:
Practice Address - City:STEWARTSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64490-7122
Practice Address - Country:US
Practice Address - Phone:816-669-3611
Practice Address - Fax:816-669-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO05611021OtherBCBSKC