Healthcare Provider Details

I. General information

NPI: 1922263086
Provider Name (Legal Business Name): MARTIN K COONEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MEDICAL PARK DR STE 1
HELENA MT
59601-4903
US

IV. Provider business mailing address

64 MEDICAL PARK DR STE 1
HELENA MT
59601-4903
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-3190
  • Fax: 406-449-9957
Mailing address:
  • Phone: 406-442-3191
  • Fax: 406-449-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2313
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2313
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: