Provider Demographics
NPI:1255817375
Name:KEVIN J. COOLIDGE DDS INC.
Entity type:Organization
Organization Name:KEVIN J. COOLIDGE DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COOLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-736-4344
Mailing Address - Street 1:866 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-7568
Mailing Address - Country:US
Mailing Address - Phone:415-730-2814
Mailing Address - Fax:
Practice Address - Street 1:500 E REMINGTON DR STE 22
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2612
Practice Address - Country:US
Practice Address - Phone:408-736-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55295261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental