Provider Demographics
NPI:1841926763
Name:CODDINGTON, NATHAN CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHARLES
Last Name:CODDINGTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 DG-AF POSTGRADUATE DENTAL SCHOOL
Mailing Address - Street 2:2133 PEPPERRELL ST, BLDG 3352
Mailing Address - City:JBSA-LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-292-6258
Mailing Address - Fax:210-292-2618
Practice Address - Street 1:3551 ROGER BROOKE DR BLDG 3600
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:541-228-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205275122300000X
TX38970390200000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program