MEDICARE: ANGELA R. COURTNEY, DDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20529	OH

General Provider Information

NPI Number	:	1588783864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA R. COURTNEY, DDS, LLC

Provider Business Mailing Address
First Line	:	1170 OLD HENDERSON RD
Second Line	:	SUITE 104
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3623
Country	:	US
Telephone Number	:	614-451-7393
Fax Number	:	614-451-7681

Provider Business Practice Location Address
First Line	:	1170 OLD HENDERSON RD
Second Line	:	SUITE 104
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3623
Country	:	US
Telephone Number	:	614-451-7393
Fax Number	:	614-451-7681

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANGELA RAE COURTNEY
Credential	:	DDS
Telephone Number	:	614-451-7393

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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