Healthcare Provider Details

I. General information

NPI: 1376129072
Provider Name (Legal Business Name): JEFFERY COON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE STE 705
SANTA ANA CA
92705-3611
US

IV. Provider business mailing address

17511 SHERBROOK DR
TUSTIN CA
92780-2502
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-8873
  • Fax:
Mailing address:
  • Phone: 786-779-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDDS111438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: