Provider Demographics
NPI:1366703274
Name:WILLIAMS, COURTNEY BOWEN (DDS)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BOWEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2953 LAKE JAMES DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3920
Mailing Address - Country:US
Mailing Address - Phone:252-799-6075
Mailing Address - Fax:
Practice Address - Street 1:5124 COPPER RIDGE DR
Practice Address - Street 2:APARTMENT 102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5564
Practice Address - Country:US
Practice Address - Phone:252-799-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist