Provider Demographics
NPI:1477560043
Name:KEVIN A. COE D.D.S., PC
Entity Type:Organization
Organization Name:KEVIN A. COE D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-281-3020
Mailing Address - Street 1:817 CHIPPEWA DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3319
Mailing Address - Country:US
Mailing Address - Phone:616-283-0170
Mailing Address - Fax:
Practice Address - Street 1:4760 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-4628
Practice Address - Country:US
Practice Address - Phone:616-281-3020
Practice Address - Fax:616-281-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID184400OtherBCBS ID #