Provider Demographics
NPI:1851628267
Name:COELHO, GARY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:COELHO
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 1:12 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6221
Mailing Address - Country:US
Mailing Address - Phone:212-686-3953
Mailing Address - Fax:212-889-5558
Practice Address - Street 1:12 E 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6221
Practice Address - Country:US
Practice Address - Phone:212-686-3953
Practice Address - Fax:212-889-5558
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics