Healthcare Provider Details

I. General information

NPI: 1609010024
Provider Name (Legal Business Name): COURTNEY ANTIONIO GREENWOOD D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY REBECCA ANTONIO D.D.S.

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 WEST ALEXIS RD.
SYLVANIA OH
43560
US

IV. Provider business mailing address

6911 PILLIOD RD.
HOLLAND OH
43528
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-7187
  • Fax: 419-882-3165
Mailing address:
  • Phone: 734-272-2118
  • Fax: 419-867-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-022958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: