MEDICARE: STEVEN MATTHEW COFFMAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5573	NV

General Provider Information

NPI Number	:	1316112022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MATTHEW COFFMAN D.M.D.

Provider Business Mailing Address
First Line	:	2002 GRAFTON AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-0602
Country	:	US
Telephone Number	:	702-300-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 S DECATUR BLVD STE 42B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5859
Country	:	US
Telephone Number	:	702-221-0783
Fax Number	:	702-221-2573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	09/26/2008

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