Provider Demographics
NPI:1538337399
Name:KEVIN T COYLE DMD PA
Entity type:Organization
Organization Name:KEVIN T COYLE DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-275-0100
Mailing Address - Street 1:295 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3123
Mailing Address - Country:US
Mailing Address - Phone:609-275-0100
Mailing Address - Fax:609-275-8870
Practice Address - Street 1:295 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-3123
Practice Address - Country:US
Practice Address - Phone:609-275-0100
Practice Address - Fax:609-275-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012312001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty