Provider Demographics
NPI:1598955247
Name:COON, MICHAEL GERALD
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERALD
Last Name:COON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 W HOUGHTON LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629
Mailing Address - Country:US
Mailing Address - Phone:989-366-6971
Mailing Address - Fax:
Practice Address - Street 1:3232 W HOUGHTON LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629
Practice Address - Country:US
Practice Address - Phone:989-366-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician