Provider Demographics
NPI:1982052296
Name:JEANETTE COURTAD, DDS
Entity type:Organization
Organization Name:JEANETTE COURTAD, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-279-5900
Mailing Address - Street 1:623 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1904
Mailing Address - Country:US
Mailing Address - Phone:303-279-5900
Mailing Address - Fax:
Practice Address - Street 1:623 14TH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1904
Practice Address - Country:US
Practice Address - Phone:303-279-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty