Provider Demographics
NPI:1811125024
Name:MOLETTIERE, COURTNEY R (DDS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:MOLETTIERE
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 1:12322 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-4267
Mailing Address - Country:US
Mailing Address - Phone:402-496-9950
Mailing Address - Fax:402-496-9778
Practice Address - Street 1:12322 EMMET ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-4267
Practice Address - Country:US
Practice Address - Phone:402-496-9950
Practice Address - Fax:402-496-9778
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice