Individual
DR. COURTNEY MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
545 E JOHNSON ST, FOND DU LAC, WI 54935-2856
(920) 924-9090
Mailing address
545 E JOHNSON ST, FOND DU LAC, WI 54935-2856
(920) 924-9090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1001957
WI
1223G0001X
General Practice Dentistry
DT2760
HI
Other
Enumeration date
07/12/2018
Last updated
10/30/2020
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