Provider Demographics
NPI:1649467457
Name:COFFMAN, WILLIAM BRENT (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRENT
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11834 BRYANT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3848
Mailing Address - Country:US
Mailing Address - Phone:909-797-2741
Mailing Address - Fax:909-797-8854
Practice Address - Street 1:11834 BRYANT ST
Practice Address - Street 2:STE 101
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-3848
Practice Address - Country:US
Practice Address - Phone:909-797-2741
Practice Address - Fax:909-797-8854
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist