Provider Demographics
NPI:1588047385
Name:COYLE, CHAD (DDS, MBA)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:COYLE
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 WALES AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9006
Mailing Address - Country:US
Mailing Address - Phone:330-832-0488
Mailing Address - Fax:330-832-1855
Practice Address - Street 1:6730 WALES AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-832-0488
Practice Address - Fax:330-832-1855
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.3606122300000X
OH30.24806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist