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General NPI Number Information
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NPI Number | 1740352707
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Entity Type | Organization
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Legal Business Name | THOMAS K. COURTNEY, DDS, UBO
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 PARK AVE
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City | STEWARTSVILLE
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State | MO
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Zip | 64490-7122
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Country | US
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Telephone | 816-669-3611
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Fax | 816-669-3253
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Provider Business Mailing Address
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Address Line | 302 PARK AVE
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City | STEWARTSVILLE
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State | MO
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Zip | 64490-7122
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Country | US
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Telephone | 816-669-3611
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Fax | 816-669-3253
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Authorized Official
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Title or Position | DIRECTING MANAGER
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Name | DR. THOMAS K COURTNEY
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Credential | D.D.S.
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Telephone | 816-669-3611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11939
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License Number State | MO
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