Provider Demographics
NPI:1952471161
Name:DRS KING COATES AND NOLAN A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:DRS KING COATES AND NOLAN A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVERSON
Authorized Official - Middle Name:DEVILLE
Authorized Official - Last Name:COATES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-323-9655
Mailing Address - Street 1:1101 ROYAL AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-323-9655
Mailing Address - Fax:318-323-9698
Practice Address - Street 1:1101 ROYAL AVE SUITE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-323-9655
Practice Address - Fax:318-323-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty