Individual
KOURTNEY KOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3234 64TH ST, LUBBOCK, TX 79413-5760
(806) 793-0651
Mailing address
5713 79TH ST, LUBBOCK, TX 79424-2607
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
36441
TX
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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