Provider Demographics
NPI:1598983504
Name:COICAN, MARK STEVEN (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:COICAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2179 JULIAN AVE NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905
Mailing Address - Country:US
Mailing Address - Phone:321-723-8727
Mailing Address - Fax:321-676-5756
Practice Address - Street 1:2179 JULIAN AVE NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905
Practice Address - Country:US
Practice Address - Phone:321-723-8727
Practice Address - Fax:321-676-5756
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN9032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist