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General NPI Number Information
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NPI Number | 1104345958
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Entity Type | Individual
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Provider Name | LONNITA LOUISE COULTER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 313-576-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 10028 ALLEN POINTE DR
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City | ALLEN PARK
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State | MI
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Zip | 48101-1785
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901022495
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License Number State | MI
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