Provider Demographics
NPI:1346484474
Name:COULTER, MARK GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:COULTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5511 SW 8TH ST
Mailing Address - Street 2:#201
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2272
Mailing Address - Country:US
Mailing Address - Phone:305-264-1200
Mailing Address - Fax:786-476-5508
Practice Address - Street 1:5511 SW 8TH ST
Practice Address - Street 2:#201
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2272
Practice Address - Country:US
Practice Address - Phone:305-264-1200
Practice Address - Fax:786-476-5508
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice