Provider Demographics
NPI:1730303249
Name:COYNER, RICHARD MASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MASON
Last Name:COYNER
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 1:7715 PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-851-9522
Mailing Address - Fax:253-851-3798
Practice Address - Street 1:7715 PIONEER WAY
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332
Practice Address - Country:US
Practice Address - Phone:253-851-9522
Practice Address - Fax:253-851-3798
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
75102OtherTRICARE