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Individual

COURTNEY ETHINGTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD, MSD

Contact information

Practice address
4 WEST DR STE 170, CHESTERFIELD, MO 63017-1793
(636) 778-9345
Mailing address
1109 E LINDEN AVE, SAINT LOUIS, MO 63117-1378

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2019043361
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
019.032433
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
019.032433
ILLINOIS DENTAL LICENSE
IL
01
2019043361
MISSOURI DENTAL LICENSE
MO
Enumeration date
12/12/2019
Last updated
12/12/2019
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