MEDICARE: DR. MARTIN C COURTNEY D.D.S.

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	31236	CA

General Provider Information

NPI Number	:	1508869595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN C COURTNEY D.D.S.

Provider Business Mailing Address
First Line	:	18911 NORDHOFF STREET
Second Line	:	SUITE #38
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324
Country	:	US
Telephone Number	:	818-886-6696
Fax Number	:	818-886-2502

Provider Business Practice Location Address
First Line	:	18911 NORDHOFF STREET
Second Line	:	SUITE #38
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324
Country	:	US
Telephone Number	:	818-886-6696
Fax Number	:	818-886-2502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/11/2015

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