Provider Demographics
NPI:1376921528
Name:BRECKINRIDGE DENTAL AND ORTHODONTICS
Entity Type:Organization
Organization Name:BRECKINRIDGE DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-898-3102
Mailing Address - Street 1:4150 E RENNER RD
Mailing Address - Street 2:#400
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2816
Mailing Address - Country:US
Mailing Address - Phone:972-248-9119
Mailing Address - Fax:
Practice Address - Street 1:4150 E RENNER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2816
Practice Address - Country:US
Practice Address - Phone:323-898-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty