Provider Demographics
NPI:1669527222
Name:COE, PRISCILLA BURT (DDS)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:BURT
Last Name:COE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10503 SEVILLA DR
Mailing Address - Street 2:# 201
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7032
Mailing Address - Country:US
Mailing Address - Phone:239-561-5139
Mailing Address - Fax:
Practice Address - Street 1:3877 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6230
Practice Address - Country:US
Practice Address - Phone:239-774-3545
Practice Address - Fax:239-774-1540
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 115761223G0001X
NC55781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice