Healthcare Provider Details

I. General information

NPI: 1508836925
Provider Name (Legal Business Name): ALVIN JOY COON D D S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 7TH ST
SAFFORD AZ
85546-2705
US

IV. Provider business mailing address

409 W 7TH ST
SAFFORD AZ
85546-2705
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-1592
  • Fax: 928-428-4321
Mailing address:
  • Phone: 928-428-1592
  • Fax: 928-428-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1877
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: