Provider Demographics
NPI:1811044902
Name:COEN, DANIEL MARK (DDS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARK
Last Name:COEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 WEST MONTGOMERY STREET
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-2407
Mailing Address - Country:US
Mailing Address - Phone:641-782-8014
Mailing Address - Fax:641-782-8490
Practice Address - Street 1:110 WEST MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-2407
Practice Address - Country:US
Practice Address - Phone:641-782-8014
Practice Address - Fax:641-782-8490
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA61181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0126664Medicaid