Provider Demographics
NPI:1316112022
Name:COFFMAN, STEVEN MATTHEW (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MATTHEW
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 GRAFTON AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0602
Mailing Address - Country:US
Mailing Address - Phone:702-300-7886
Mailing Address - Fax:
Practice Address - Street 1:4001 S DECATUR BLVD STE 42B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5859
Practice Address - Country:US
Practice Address - Phone:702-221-0783
Practice Address - Fax:702-221-2573
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist