Provider Demographics
NPI:1528442548
Name:CHRISTOPHER C. COGGUILLO DDS PC
Entity type:Organization
Organization Name:CHRISTOPHER C. COGGUILLO DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHAPMAN
Authorized Official - Last Name:COGGUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-874-0000
Mailing Address - Street 1:PO BOX 5185
Mailing Address - Street 2:203 CHERRY ST.
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-874-0000
Mailing Address - Fax:203-874-4986
Practice Address - Street 1:203 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILDORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-874-0000
Practice Address - Fax:203-874-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty