Healthcare Provider Details

I. General information

NPI: 1770230880
Provider Name (Legal Business Name): JUSTIN C COURTNEY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W SMITH ST STE 206
KENT WA
98032-4477
US

IV. Provider business mailing address

655 W SMITH ST STE 206
KENT WA
98032-4477
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-8306
  • Fax:
Mailing address:
  • Phone: 253-854-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN COURTNEY
Title or Position: MEMBER
Credential: DDS
Phone: 532-854-8306