Provider Demographics
NPI:1629220058
Name:COOMBE, KEVIN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:COOMBE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 SW RIMROCK WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1941
Mailing Address - Country:US
Mailing Address - Phone:541-923-7633
Mailing Address - Fax:541-923-8733
Practice Address - Street 1:774 SW RIMROCK WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1941
Practice Address - Country:US
Practice Address - Phone:541-923-7633
Practice Address - Fax:541-923-8733
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6510C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice