Provider Demographics
NPI:1528044039
Name:COATES, GERALD L JR (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:COATES
Suffix:JR
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 STONEBRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-9553
Mailing Address - Country:US
Mailing Address - Phone:252-447-3100
Mailing Address - Fax:252-447-0144
Practice Address - Street 1:92 STONEBRIDGE TRL
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-9553
Practice Address - Country:US
Practice Address - Phone:252-447-3100
Practice Address - Fax:252-447-0144
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991681Medicaid