Provider Demographics
NPI:1740573575
Name:COFFIN, KYLE SHAUGHNESSY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:SHAUGHNESSY
Last Name:COFFIN
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 1:514 TENAHA ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3402
Mailing Address - Country:US
Mailing Address - Phone:936-598-6181
Mailing Address - Fax:936-598-9138
Practice Address - Street 1:514 TENAHA ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3402
Practice Address - Country:US
Practice Address - Phone:936-598-6181
Practice Address - Fax:936-598-9138
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA61521223G0001X
TX294651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice