Healthcare Provider Details

I. General information

NPI: 1033102660
Provider Name (Legal Business Name): PATRICK J COYNE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 INDIAN WELLS RD
ALAMOGORDO NM
88310-3861
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-0446
  • Fax: 575-439-0622
Mailing address:
  • Phone: 575-267-3280
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2393
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: