Provider Demographics
NPI:1306404389
Name:COE, GABRIELLE (DMD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:COE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:IL
Mailing Address - Zip Code:61723-0445
Mailing Address - Country:US
Mailing Address - Phone:217-648-2828
Mailing Address - Fax:
Practice Address - Street 1:205 S RACE ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:IL
Practice Address - Zip Code:61723-7586
Practice Address - Country:US
Practice Address - Phone:217-648-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0321481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice