Provider Demographics
NPI:1215314455
Name:DONALD E COUCHMAN DDS PC
Entity type:Organization
Organization Name:DONALD E COUCHMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:COUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-593-0263
Mailing Address - Street 1:5145 CENTENNIAL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4425
Mailing Address - Country:US
Mailing Address - Phone:719-593-0263
Mailing Address - Fax:719-593-0287
Practice Address - Street 1:5145 CENTENNIAL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4425
Practice Address - Country:US
Practice Address - Phone:719-593-0263
Practice Address - Fax:719-593-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00100940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty