Provider Demographics
NPI:1104455401
Name:COBURN, GRACE ELIZABETH BECK (DMD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ELIZABETH BECK
Last Name:COBURN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GALLERIA DR STE 206
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2196
Mailing Address - Country:US
Mailing Address - Phone:831-566-5107
Mailing Address - Fax:
Practice Address - Street 1:3100 GALLERIA DR STE 206
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-885-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics