Provider Demographics
NPI:1699143115
Name:NOWICKI, COURTNEY (DDS, MS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:NOWICKI
Suffix:
Gender:
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 RIDGELINE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-9102
Mailing Address - Country:US
Mailing Address - Phone:419-234-8153
Mailing Address - Fax:
Practice Address - Street 1:3033 RIDGELINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-9102
Practice Address - Country:US
Practice Address - Phone:727-934-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist