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General NPI Number Information
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NPI Number | 1548631443
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Entity Type | Individual
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Provider Name | JONATHAN COUTIN DDS
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Gender | Male
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Dates
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Enumeration Date | 10/18/2015
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 550 E WASHINGTON BLVD STE 100
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City | CRESCENT CITY
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State | CA
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Zip | 95531-8161
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Country | US
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Telephone | 707-465-6925
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Fax | 707-387-9808
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Provider Business Mailing Address
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Address Line | 600 SW COLUMBIA ST STE 6250
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City | BEND
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State | OR
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Zip | 97702-1099
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Country | US
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Telephone | 541-323-3181
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Fax | 541-706-9897
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D11536
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31416
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 100090
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License Number State | CA
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