Healthcare Provider Details

I. General information

NPI: 1205940384
Provider Name (Legal Business Name): MATTHEW JONATHAN COATS D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W MAIN ST
TOMBALL TX
77375-5525
US

IV. Provider business mailing address

1017 W MAIN ST
TOMBALL TX
77375-5525
US

V. Phone/Fax

Practice location:
  • Phone: 281-255-4746
  • Fax:
Mailing address:
  • Phone: 281-255-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15970
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: