Provider Demographics
NPI:1336907195
Name:CHARLES F COON DDS PLLC
Entity Type:Organization
Organization Name:CHARLES F COON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FULCHER
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-648-4503
Mailing Address - Street 1:7 MARIONET CIR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-5903
Mailing Address - Country:US
Mailing Address - Phone:517-648-4503
Mailing Address - Fax:
Practice Address - Street 1:701 NW MCNELLY RD STE 13
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-9160
Practice Address - Country:US
Practice Address - Phone:517-648-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental