Healthcare Provider Details

I. General information

NPI: 1649952417
Provider Name (Legal Business Name): ERIC COY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 OLD FARM DR STE F
FREDERICK MD
21702-5404
US

IV. Provider business mailing address

244 VISTA GLEN RD
WALKERSVILLE MD
21793-6011
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0181
  • Fax:
Mailing address:
  • Phone: 240-709-9249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18650
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: