Provider Demographics
NPI:1891816971
Name:COUGHLIN, NANCY J (DDS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 5TH AVE
Mailing Address - Street 2:SUITE 1855
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10111-0100
Mailing Address - Country:US
Mailing Address - Phone:212-332-1020
Mailing Address - Fax:212-332-1025
Practice Address - Street 1:630 5TH AVE
Practice Address - Street 2:SUITE 1855
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10111-0100
Practice Address - Country:US
Practice Address - Phone:212-332-1020
Practice Address - Fax:212-332-1025
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0422051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice