MEDICARE: CHARLES F COON DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336907195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES F COON DDS PLLC

Provider Business Mailing Address
First Line	:	7 MARIONET CIR
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72714-5903
Country	:	US
Telephone Number	:	517-648-4503
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 NW MCNELLY RD STE 13
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-9160
Country	:	US
Telephone Number	:	517-648-4503
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. CHARLES FULCHER COON
Credential	:	DDS
Telephone Number	:	517-648-4503

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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