Provider Demographics
NPI:1114208394
Name:JCOYNEDDS LLC
Entity Type:Organization
Organization Name:JCOYNEDDS LLC
Other - Org Name:COYNE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-298-2424
Mailing Address - Street 1:1749 DELCO PARK DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1398
Mailing Address - Country:US
Mailing Address - Phone:937-298-2424
Mailing Address - Fax:937-298-2304
Practice Address - Street 1:1749 DELCO PARK DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1398
Practice Address - Country:US
Practice Address - Phone:937-298-2424
Practice Address - Fax:937-298-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-220961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty