Healthcare Provider Details

I. General information

NPI: 1912119132
Provider Name (Legal Business Name): MARY COYNE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25882 ORCHARD LAKE RD. SUITE 105
FARMINGTON HILLS MI
48336
US

IV. Provider business mailing address

7951 CRAIN HWY S LOWER LEVEL
GLEN BURNIE MD
21061-4934
US

V. Phone/Fax

Practice location:
  • Phone: 248-442-6600
  • Fax: 888-330-4331
Mailing address:
  • Phone: 410-969-9300
  • Fax: 410-969-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7624
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: