Provider Demographics
NPI:1639259047
Name:COYLE, ROBERT DALE (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:COYLE
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 1:1000 N NIFONG
Mailing Address - Street 2:BLDG 6 SUITE 130
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-874-1990
Mailing Address - Fax:573-874-1923
Practice Address - Street 1:1000 N NIFONG
Practice Address - Street 2:BLDG 6 SUITE 130
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-874-1990
Practice Address - Fax:573-874-1923
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0160561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry