Provider Demographics
NPI:1568464527
Name:COATES, DAVID BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:COATES
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 1:2204 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2933
Mailing Address - Country:US
Mailing Address - Phone:765-447-0525
Mailing Address - Fax:765-447-5815
Practice Address - Street 1:2204 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2933
Practice Address - Country:US
Practice Address - Phone:765-447-0525
Practice Address - Fax:765-447-5815
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100445200AMedicaid
INT92324Medicare UPIN
IN100445200AMedicaid