Healthcare Provider Details

I. General information

NPI: 1942218532
Provider Name (Legal Business Name): PETER L. COOMBS, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MOUNTAIN RD
SUFFIELD CT
06078-2083
US

IV. Provider business mailing address

110 MOUNTAIN RD
SUFFIELD CT
06078-2083
US

V. Phone/Fax

Practice location:
  • Phone: 860-668-0283
  • Fax: 860-668-0249
Mailing address:
  • Phone: 860-668-0283
  • Fax: 860-668-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7290
License Number StateCT

VIII. Authorized Official

Name: DR. PETER L. COOMBS
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 860-668-0283