Provider Demographics
NPI:1992883169
Name:COURTNEY, ANGELA RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RAE
Last Name:COURTNEY
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 1:1170 OLD W HENDERSON ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-451-7393
Mailing Address - Fax:614-451-7681
Practice Address - Street 1:1170 OLD W HENDERSON ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-451-7393
Practice Address - Fax:614-451-7681
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH205291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice