Provider Demographics
NPI:1073533733
Name:COATES, BRIAN SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SEAN
Last Name:COATES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 PINEDALE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2019
Mailing Address - Country:US
Mailing Address - Phone:336-282-5331
Mailing Address - Fax:336-282-0554
Practice Address - Street 1:2707 PINEDALE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2019
Practice Address - Country:US
Practice Address - Phone:336-282-5331
Practice Address - Fax:336-282-0554
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC902FMMedicaid