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General NPI Number Information
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NPI Number | 1336907195
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Entity Type | Organization
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Legal Business Name | CHARLES F COON DDS PLLC
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 701 NW MCNELLY RD STE 13
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City | BENTONVILLE
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State | AR
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Zip | 72712-9160
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Country | US
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Telephone | 517-648-4503
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MARIONET CIR
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City | BELLA VISTA
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State | AR
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Zip | 72714-5903
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Country | US
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Telephone | 517-648-4503
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CHARLES FULCHER COON
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Credential | DDS
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Telephone | 517-648-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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