Provider Demographics
NPI:1245542646
Name:COUGHLIN, CORINNE ANNE
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ANNE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CORINNE
Other - Middle Name:ANNE
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:18 CENTRAL SQ
Mailing Address - Street 2:
Mailing Address - City:W BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1742
Mailing Address - Country:US
Mailing Address - Phone:508-583-1883
Mailing Address - Fax:508-232-7491
Practice Address - Street 1:18 CENTRAL SQ
Practice Address - Street 2:
Practice Address - City:W BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1742
Practice Address - Country:US
Practice Address - Phone:508-583-1883
Practice Address - Fax:508-232-7491
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist