Provider Demographics
NPI:1710903695
Name:COYNE, JOHN F (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:COYNE
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 1:951 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1552
Mailing Address - Country:US
Mailing Address - Phone:508-588-0200
Mailing Address - Fax:508-583-6156
Practice Address - Street 1:951 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1552
Practice Address - Country:US
Practice Address - Phone:508-588-0200
Practice Address - Fax:508-583-6156
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18127204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX20040Medicare ID - Type UnspecifiedINDIVIDUAL
MAU77420Medicare UPIN