Healthcare Provider Details

I. General information

NPI: 1386953958
Provider Name (Legal Business Name): CHAD JEFFREY COOMBS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-1004
  • Fax:
Mailing address:
  • Phone: 801-777-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7774052-9923
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10758
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7774052-9921
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4588
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: