Provider Demographics
NPI:1871849935
Name:COONS, MARK CHRISTOPHER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:COONS
Suffix:JR
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 1:1121 LAKE AIR DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4417
Mailing Address - Country:US
Mailing Address - Phone:254-772-8330
Mailing Address - Fax:
Practice Address - Street 1:1121 LAKE AIR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4417
Practice Address - Country:US
Practice Address - Phone:254-772-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist