Provider Demographics
NPI:1912125899
Name:JATANA, COURTNEY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANN
Last Name:JATANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:ZADELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:305 W. 12TH AVE.
Mailing Address - Street 2:RM 2101
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-292-5144
Mailing Address - Fax:614-292-1103
Practice Address - Street 1:305 W. 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-292-5144
Practice Address - Fax:614-292-1103
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023557122300000X
OHLIMITED TEACHING1223S0112X
OH30.023557204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery