Provider Demographics
NPI:1194806083
Name:COURTNEY, BRIAN W (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:COURTNEY
Suffix:
Gender:M
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:ONE GOLD ST.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103
Mailing Address - Country:US
Mailing Address - Phone:860-728-5264
Mailing Address - Fax:860-527-0932
Practice Address - Street 1:ONE GOLD ST.
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:860-728-5264
Practice Address - Fax:860-527-0932
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist