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General NPI Number Information
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NPI Number | 1942450994
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Entity Type | Individual
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Provider Name | DAVID BRIAN COYNER
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Gender | Male
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 4115 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4331
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Country | US
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Telephone | 253-565-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 N 21ST ST
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City | TACOMA
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State | WA
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Zip | 98406-6613
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Country | US
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Telephone | 253-579-7960
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00009115
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License Number State | WA
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