Provider Demographics
NPI:1376439620
Name:ROBERT B COON DMD PLLC
Entity type:Organization
Organization Name:ROBERT B COON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRAND
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:313-505-4573
Mailing Address - Street 1:3505 W CLARK RD APT U203
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9460
Mailing Address - Country:US
Mailing Address - Phone:313-505-4573
Mailing Address - Fax:
Practice Address - Street 1:204 S BOSTWICK ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1801
Practice Address - Country:US
Practice Address - Phone:313-505-4573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental