Provider Demographics
NPI:1104830587
Name:COELER, AMY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:S
Last Name:COELER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38269OtherDELTA DENTAL
CA792135OtherUCCI