MEDICARE: DR. DAVID BRIAN COATES D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12008777	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568464527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRIAN COATES D.D.S.

Provider Business Mailing Address
First Line	:	2204 SCOTT ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2933
Country	:	US
Telephone Number	:	765-447-0525
Fax Number	:	765-447-5815

Provider Business Practice Location Address
First Line	:	2204 SCOTT ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2933
Country	:	US
Telephone Number	:	765-447-0525
Fax Number	:	765-447-5815

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	09/28/2010

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Directions to “ DR. DAVID BRIAN COATES D.D.S.” Practice Location

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