Provider Demographics
NPI:1407075138
Name:COULTER, WILLIAM BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:COULTER
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 1:325 PARK PL
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3556
Mailing Address - Country:US
Mailing Address - Phone:574-271-8771
Mailing Address - Fax:574-271-5591
Practice Address - Street 1:325 PARK PL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3556
Practice Address - Country:US
Practice Address - Phone:574-271-8771
Practice Address - Fax:574-271-5591
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN9556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist