Provider Demographics
NPI:1265652077
Name:CRAIG L. COOMBS D.D.S., PC
Entity Type:Organization
Organization Name:CRAIG L. COOMBS D.D.S., PC
Other - Org Name:COOMBS ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-773-5836
Mailing Address - Street 1:2185 ROBINS DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1154
Mailing Address - Country:US
Mailing Address - Phone:801-773-5836
Mailing Address - Fax:801-773-5130
Practice Address - Street 1:2185 ROBINS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1154
Practice Address - Country:US
Practice Address - Phone:801-773-5836
Practice Address - Fax:801-773-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1381051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529664312016Medicaid