Provider Demographics
NPI:1073775102
Name:OAKBERRY DENTAL
Entity Type:Organization
Organization Name:OAKBERRY DENTAL
Other - Org Name:AMY S. COELER D.D.S
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:COELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-924-9716
Mailing Address - Street 1:456 W D ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2612
Mailing Address - Country:US
Mailing Address - Phone:559-924-9716
Mailing Address - Fax:559-924-9772
Practice Address - Street 1:456 W D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2612
Practice Address - Country:US
Practice Address - Phone:559-924-9716
Practice Address - Fax:559-924-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty