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General NPI Number Information
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NPI Number | 1194943084
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Entity Type | Organization
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Legal Business Name | DR MARK S COICAN PA
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2179 JULIAN AVE NE SUITE 2
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City | PALM BAY
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State | FL
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Zip | 32905-4042
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Country | US
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Telephone | 321-723-8727
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Fax | 321-676-5756
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Provider Business Mailing Address
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Address Line | 2179 JULIAN AVE NE SUITE 2
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City | PALM BAY
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State | FL
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Zip | 32905-4042
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Country | US
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Telephone | 321-723-8727
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Fax | 321-676-5756
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK STEVEN COICAN
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Credential | DMD MS
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Telephone | 321-723-8727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN9032
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License Number State | FL
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