Provider Demographics
NPI:1114511656
Name:COULON DENTAL CARE
Entity Type:Organization
Organization Name:COULON DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:KACI
Authorized Official - Middle Name:
Authorized Official - Last Name:AWBREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-238-4146
Mailing Address - Street 1:3000 N GARFIELD ST STE 220
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6417
Mailing Address - Country:US
Mailing Address - Phone:432-683-5313
Mailing Address - Fax:
Practice Address - Street 1:3000 N GARFIELD ST STE 220
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6417
Practice Address - Country:US
Practice Address - Phone:432-683-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty