Provider Demographics
NPI:1376644823
Name:COE, ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:COE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3354
Mailing Address - Country:US
Mailing Address - Phone:760-743-1896
Mailing Address - Fax:760-743-4269
Practice Address - Street 1:140 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3354
Practice Address - Country:US
Practice Address - Phone:760-743-1896
Practice Address - Fax:760-743-4269
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32285OtherLICENSE