Provider Demographics
NPI:1568687820
Name:COATES, DAVID J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
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 1:4441 LENNOX DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9770
Mailing Address - Country:US
Mailing Address - Phone:801-282-8659
Mailing Address - Fax:
Practice Address - Street 1:2651 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8953
Practice Address - Country:US
Practice Address - Phone:801-254-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374035-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice