Healthcare Provider Details

I. General information

NPI: 1104627686
Provider Name (Legal Business Name): PATRICK J COYNE DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 INDIAN WELLS RD
ALAMOGORDO NM
88310-3861
US

IV. Provider business mailing address

2832 INDIAN WELLS RD
ALAMOGORDO NM
88310-3861
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK J COYNE
Title or Position: OWNER
Credential: DDS
Phone: 575-439-0446