Provider Demographics
NPI:1760131643
Name:COATS, KEVIN JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:COATS
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 1:16363 LOTHROP CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2004
Mailing Address - Country:US
Mailing Address - Phone:303-709-1576
Mailing Address - Fax:
Practice Address - Street 1:1305 SUMNER ST UNIT 300
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3270
Practice Address - Country:US
Practice Address - Phone:303-776-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program