Provider Demographics
NPI:1174713069
Name:COURTIN, MARY (DDS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:COURTIN
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 1:991 EI30
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4824
Mailing Address - Country:US
Mailing Address - Phone:972-722-0022
Mailing Address - Fax:972-722-0017
Practice Address - Street 1:991 E INTERSTATE 30
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4824
Practice Address - Country:US
Practice Address - Phone:972-722-0022
Practice Address - Fax:972-722-0017
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23482OtherCHIP NUMBER